Provider Demographics
NPI:1457719767
Name:NARISSA R. GRIFFIN, PH.D., PLLC
Entity Type:Organization
Organization Name:NARISSA R. GRIFFIN, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NARISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-629-4304
Mailing Address - Street 1:11417 N HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72946-3641
Mailing Address - Country:US
Mailing Address - Phone:479-629-4304
Mailing Address - Fax:
Practice Address - Street 1:5401 ROGERS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3745
Practice Address - Country:US
Practice Address - Phone:479-242-4560
Practice Address - Fax:479-242-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11-21P251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1457515108OtherNPI
ARARK001574Medicaid