Provider Demographics
NPI:1932553138
Name:GRIFFIN, TERRY (LPCC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7907
Mailing Address - Country:US
Mailing Address - Phone:505-559-3795
Mailing Address - Fax:
Practice Address - Street 1:11 PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-7907
Practice Address - Country:US
Practice Address - Phone:505-559-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1702101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health