Provider Demographics
NPI:1841374600
Name:GRIFFITHS, JOHN KENT (DSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENT
Last Name:GRIFFITHS
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 S 900 E STE 212
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3913
Mailing Address - Country:US
Mailing Address - Phone:801-268-6558
Mailing Address - Fax:
Practice Address - Street 1:4885 S 900 E STE 212
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-3913
Practice Address - Country:US
Practice Address - Phone:801-268-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112462-35011041C0700X
UT112462-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist