Provider Demographics
NPI:1831397785
Name:GRIFFITH, BETH ANN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 75TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4521
Mailing Address - Country:US
Mailing Address - Phone:317-525-2497
Mailing Address - Fax:
Practice Address - Street 1:144 RAILROAD AVE STE 205A
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4121
Practice Address - Country:US
Practice Address - Phone:317-348-4094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005166A1041C0700X
WALW605505661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical