Provider Demographics
NPI:1063811289
Name:GRIFFITH, HEATHER (MED, EDS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 INDIANOLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1862
Mailing Address - Country:US
Mailing Address - Phone:614-964-1234
Mailing Address - Fax:614-924-7161
Practice Address - Street 1:4770 INDIANOLA AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1862
Practice Address - Country:US
Practice Address - Phone:614-964-1234
Practice Address - Fax:614-924-7161
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3170952103TS0200X
OHSP.00637103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool