Provider Demographics
NPI:1164774048
Name:GRIFFIS, KELLY ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:GRIFFIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 TIMBER TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-9149
Mailing Address - Country:US
Mailing Address - Phone:407-716-2049
Mailing Address - Fax:
Practice Address - Street 1:4083 TIMBER TRAIL CT
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9149
Practice Address - Country:US
Practice Address - Phone:407-716-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health