Provider Demographics
NPI:1184638553
Name:GRIFFITH, THOMAS R (MA, MDIV, DD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MA, MDIV, DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 TOM RAY DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9713
Mailing Address - Country:US
Mailing Address - Phone:530-268-6469
Mailing Address - Fax:
Practice Address - Street 1:5777 MADISON AVE STE 240
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3308
Practice Address - Country:US
Practice Address - Phone:916-344-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist