Provider Demographics
NPI:1730642059
Name:GRIFFIN, EVAN ROBERT (MFT, LMFT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:ROBERT
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 CLUBHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8519
Mailing Address - Country:US
Mailing Address - Phone:610-349-4138
Mailing Address - Fax:
Practice Address - Street 1:3201 HIGHFIELD DR STE F
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1113
Practice Address - Country:US
Practice Address - Phone:610-663-4248
Practice Address - Fax:484-893-2776
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty