Provider Demographics
NPI:1285906339
Name:GRIFFIN, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6590 TUMBLEWEED RIDGE LN
Mailing Address - Street 2:#101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1457
Mailing Address - Country:US
Mailing Address - Phone:702-236-8092
Mailing Address - Fax:
Practice Address - Street 1:6590 TUMBLEWEED RIDGE LN
Practice Address - Street 2:#101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1457
Practice Address - Country:US
Practice Address - Phone:702-236-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health