Provider Demographics
NPI:1790871325
Name:GRIFFIN, ROBIN G (LCSW, LPC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:G
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 1544
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039
Mailing Address - Country:US
Mailing Address - Phone:817-545-1972
Mailing Address - Fax:817-283-0819
Practice Address - Street 1:2700 TIBBETS DR.
Practice Address - Street 2:SUITE 408
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-545-1972
Practice Address - Fax:817-283-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027953101Medicaid
TX00799EMedicare ID - Type Unspecified