Provider Demographics
NPI:1831264498
Name:GRIFFITH, LOUISE AGNES (MA, LP)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:AGNES
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17637 KETTERING TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9344
Mailing Address - Country:US
Mailing Address - Phone:952-484-3100
Mailing Address - Fax:952-898-4645
Practice Address - Street 1:14575 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5722
Practice Address - Country:US
Practice Address - Phone:952-484-3100
Practice Address - Fax:952-898-4645
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1776103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist