Provider Demographics
NPI:1013527050
Name:GRIFFIN, EMMA (LPC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
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 1:7271 GAYOLA PL
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-2317
Mailing Address - Country:US
Mailing Address - Phone:830-889-6690
Mailing Address - Fax:
Practice Address - Street 1:1200 LAKE SAINT LOUIS BLVD STE 232
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1325
Practice Address - Country:US
Practice Address - Phone:314-277-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017030649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional