Provider Demographics
NPI:1124610670
Name:NOVA M. GRIFFITH, PH.D., PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:NOVA M. GRIFFITH, PH.D., PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LISC CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOVA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:618-969-2922
Mailing Address - Street 1:400 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-1539
Mailing Address - Country:US
Mailing Address - Phone:618-969-2922
Mailing Address - Fax:
Practice Address - Street 1:121 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTON CITY
Practice Address - State:IL
Practice Address - Zip Code:62951-1602
Practice Address - Country:US
Practice Address - Phone:618-969-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVA M. GRIFFITH, PH.D., PSYCHOLOGICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty