Provider Demographics
NPI:1417091091
Name:GRIFFIN, LAJEAN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LAJEAN
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:LAJEAN
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 4085
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-0485
Mailing Address - Country:US
Mailing Address - Phone:626-391-4011
Mailing Address - Fax:
Practice Address - Street 1:1175 E GARVEY ST STE 100
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3677
Practice Address - Country:US
Practice Address - Phone:626-967-6421
Practice Address - Fax:626-967-9670
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical