Provider Demographics
NPI:1376919530
Name:GRIFFIN, BRANDY MICHELLE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:MICHELLE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 STOLL POOLE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3675
Mailing Address - Country:US
Mailing Address - Phone:859-285-3698
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-227-2337
Practice Address - Fax:859-268-2472
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261965103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist