Provider Demographics
NPI:1588817985
Name:GRIFFIN, IVY CLAIRE (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:IVY
Middle Name:CLAIRE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 X ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-2300
Mailing Address - Country:US
Mailing Address - Phone:916-287-3430
Mailing Address - Fax:
Practice Address - Street 1:1614 X ST
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2300
Practice Address - Country:US
Practice Address - Phone:916-287-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55OtherMEDI-CAL/LPHA