Provider Demographics
NPI:1407153687
Name:GRIFFITH, LOIS K (MSC LMFT)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:K
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MSC LMFT
Other - Prefix:MS
Other - First Name:LOIS
Other - Middle Name:K
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4260 N WISHON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-3728
Mailing Address - Country:US
Mailing Address - Phone:559-422-0077
Mailing Address - Fax:559-446-0525
Practice Address - Street 1:191 W SHAW AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2807
Practice Address - Country:US
Practice Address - Phone:559-422-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEIN 27-3791479OtherEMPLOYER IDENTIFICATION NUMBER