Provider Demographics
NPI:1326417320
Name:DR. MEREDITH GRIFFIN
Entity type:Organization
Organization Name:DR. MEREDITH GRIFFIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-504-4680
Mailing Address - Street 1:7120 S 29TH ST
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5802
Mailing Address - Country:US
Mailing Address - Phone:402-937-4719
Mailing Address - Fax:402-261-5405
Practice Address - Street 1:7120 S 29TH ST
Practice Address - Street 2:SUITE # 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5802
Practice Address - Country:US
Practice Address - Phone:402-937-4719
Practice Address - Fax:402-261-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-20
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty