Provider Demographics
NPI:1659675189
Name:GRIFFITHS, MARILYN JANE (TLLP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JANE
Last Name:GRIFFITHS
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4384 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9311
Mailing Address - Country:US
Mailing Address - Phone:269-982-3832
Mailing Address - Fax:269-408-8091
Practice Address - Street 1:211 HILLTOP RD
Practice Address - Street 2:STE. H
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2300
Practice Address - Country:US
Practice Address - Phone:269-326-0659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014082103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling