Provider Demographics
NPI:1851515266
Name:GRIFFIN, MARSHA GAYLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:GAYLE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 MAIN STREET
Mailing Address - Street 2:SUITE 420
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4033
Mailing Address - Country:US
Mailing Address - Phone:214-741-1615
Mailing Address - Fax:214-741-1506
Practice Address - Street 1:1412 MAIN STREET
Practice Address - Street 2:SUITE 420
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-4033
Practice Address - Country:US
Practice Address - Phone:214-741-1615
Practice Address - Fax:214-741-1506
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH0049ROtherBLUE CROSS BLUE SHIELD