Provider Demographics
NPI:1821208604
Name:GRIFFIN, AMANDA BETH (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 RUNNINGRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2058
Mailing Address - Country:US
Mailing Address - Phone:636-399-5853
Mailing Address - Fax:
Practice Address - Street 1:2030 RUNNINGRIDGE CT
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2058
Practice Address - Country:US
Practice Address - Phone:636-399-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024707101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor