Provider Demographics
NPI:1336159276
Name:GRIFFIN, JAMES J (PSYD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 COUNTY HOME RD
Mailing Address - Street 2:120
Mailing Address - City:TODDVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52341-9726
Mailing Address - Country:US
Mailing Address - Phone:319-393-6796
Mailing Address - Fax:319-378-8621
Practice Address - Street 1:3550 COUNTY HOME RD
Practice Address - Street 2:120
Practice Address - City:TODDVILLE
Practice Address - State:IA
Practice Address - Zip Code:52341-9726
Practice Address - Country:US
Practice Address - Phone:319-393-6796
Practice Address - Fax:319-378-8621
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00807103T00000X
IA00337103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23629OtherWELLMARK
IA23629OtherWELLMARK