Provider Demographics
NPI:1346001690
Name:GRIFFITH, GALEN LEE (PH D)
Entity type:Individual
Prefix:DR
First Name:GALEN
Middle Name:LEE
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3495
Mailing Address - Country:US
Mailing Address - Phone:765-641-4744
Mailing Address - Fax:765-641-3810
Practice Address - Street 1:1100 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3495
Practice Address - Country:US
Practice Address - Phone:765-641-4744
Practice Address - Fax:765-641-3810
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010477103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling