Provider Demographics
NPI:1083889224
Name:GRIFFIN, HEATHER RENEE (EDD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RENEE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:EDD, BCBA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:MUMMAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:5000 BUSINESS CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7423
Practice Address - Country:US
Practice Address - Phone:912-295-4956
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TM1800X
GA1-05-2367103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities