Provider Demographics
NPI:1720527104
Name:GRIFFITH, JENNIFER LEE (MHP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:73730-1505
Mailing Address - Country:US
Mailing Address - Phone:580-478-6385
Mailing Address - Fax:
Practice Address - Street 1:610 N COVINGTON ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OK
Practice Address - Zip Code:73730-1505
Practice Address - Country:US
Practice Address - Phone:580-478-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5844-P101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health