Provider Demographics
NPI:1275636995
Name:GRIFFITH, BEVERLY JANE (MFT TRAINEE MDIV)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:JANE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MFT TRAINEE MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4832 E BUTLER AVE
Mailing Address - Street 2:APT D
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727
Mailing Address - Country:US
Mailing Address - Phone:559-457-8300
Mailing Address - Fax:
Practice Address - Street 1:1734 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711
Practice Address - Country:US
Practice Address - Phone:559-439-2647
Practice Address - Fax:559-439-2214
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program