Provider Demographics
NPI:1639688724
Name:NOVA M. GRIFFITH, PH.D., PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:NOVA M. GRIFFITH, PH.D., PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,LIC. CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:618-969-2922
Mailing Address - Street 1:400 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-1539
Mailing Address - Country:US
Mailing Address - Phone:618-696-2922
Mailing Address - Fax:
Practice Address - Street 1:121 N 13TH ST STE 2
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3255
Practice Address - Country:US
Practice Address - Phone:618-969-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty