Provider Demographics
NPI:1255973350
Name:GRIFFIN, BRANDON J (PHD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 HIGHWAY 201 S
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5543
Mailing Address - Country:US
Mailing Address - Phone:870-405-0558
Mailing Address - Fax:
Practice Address - Street 1:2117 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-2321
Practice Address - Country:US
Practice Address - Phone:870-405-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19-08P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical