Provider Demographics
NPI:1134743750
Name:GRIFFIN, DOUGLAS SPENCER (LPC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:SPENCER
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:SPENCER
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:7271 GAYOLA PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-2317
Mailing Address - Country:US
Mailing Address - Phone:573-380-2573
Mailing Address - Fax:
Practice Address - Street 1:1715 DEER TRACKS TRL STE 260
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1855
Practice Address - Country:US
Practice Address - Phone:314-884-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional