Basic Information
| Provider Information | |||||||||
| NPI: | 1457719767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NARISSA R. GRIFFIN, PH.D., PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11417 N HIGHWAY 71 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAINBURG | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729463641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796294304 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5401 ROGERS AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729033745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792424560 | ||||||||
| FaxNumber: | 4792424561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2016 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFIN | ||||||||
| AuthorizedOfficialFirstName: | NARISSA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4796294304 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 11-21P | AR | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1457515108 | 01 | AR | NPI | OTHER | ARK001574 | 05 | AR | MEDICAID |