Provider Demographics
NPI:1770903577
Name:GRIFFIN, PRISCILLA ANN (MS)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12461 S 1510 W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7092
Mailing Address - Country:US
Mailing Address - Phone:801-913-8739
Mailing Address - Fax:801-913-8739
Practice Address - Street 1:12461 S 1510 W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7092
Practice Address - Country:US
Practice Address - Phone:801-913-8739
Practice Address - Fax:801-913-8739
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8478399-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist