Provider Demographics
NPI:1861440844
Name:GRIFFIN, JOHN MONTGOMERY JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MONTGOMERY
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:PHD
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Mailing Address - Street 1:16404 SMOKEY POINT BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8417
Mailing Address - Country:US
Mailing Address - Phone:360-651-0610
Mailing Address - Fax:360-651-0656
Practice Address - Street 1:16404 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8417
Practice Address - Country:US
Practice Address - Phone:360-651-0610
Practice Address - Fax:360-651-0656
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA1564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA483531OtherVALUE OPTIONS
WA0198265OtherDEPT OFLABOR & INDUSTRIES
WA297445100000OtherPREMARA BLUE CROSS
WA417158OtherDEPARTMENT OF DISABILITIE
WA2497GROtherREGENCE BLUE SHIELD
WA7049695Medicaid
WA8913453OtherCRIME VICTIMS COMPENSATIO
WA0005893652OtherAETNA PIN
WA8850538Medicare PIN