Provider Demographics
NPI:1467731018
Name:GRIFFITH, THERESA ANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BAILIWICK DR
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-9750
Mailing Address - Country:US
Mailing Address - Phone:417-718-0771
Mailing Address - Fax:
Practice Address - Street 1:1059 BARTON DR
Practice Address - Street 2:
Practice Address - City:FORDLAND
Practice Address - State:MO
Practice Address - Zip Code:65652-7350
Practice Address - Country:US
Practice Address - Phone:417-767-2273
Practice Address - Fax:417-767-4054
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health