Provider Demographics
NPI:1255486510
Name:GRIFFIN, MARILYN ROSE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ROSE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:MARILYN
Other - Middle Name:ROSE
Other - Last Name:TULOWITZKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2330 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7781
Mailing Address - Country:US
Mailing Address - Phone:916-287-0227
Mailing Address - Fax:916-781-6974
Practice Address - Street 1:2330 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7781
Practice Address - Country:US
Practice Address - Phone:916-287-0227
Practice Address - Fax:916-781-6974
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist