Provider Demographics
NPI:1851501035
Name:GRIFFEE, JERRY (MFA, RAS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:GRIFFEE
Suffix:
Gender:M
Credentials:MFA, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2551
Mailing Address - Country:US
Mailing Address - Phone:310-207-4322
Mailing Address - Fax:310-207-6511
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:310-207-4322
Practice Address - Fax:310-207-6511
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0504101711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)