Provider Demographics
NPI:1669813838
Name:GRIFFIN, RUSSELL DEAN (MS, LPC, LCDC, CRC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:DEAN
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MS, LPC, LCDC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 BENT OAKS CT
Mailing Address - Street 2:200
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 BENT OAKS CT
Practice Address - Street 2:200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8000
Practice Address - Country:US
Practice Address - Phone:940-387-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67927101Y00000X
TX12169101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)