Basic Information
| Provider Information | |||||||||
| NPI: | 1467721373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL GRIFFITH, LCSW, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4906 AMBASSADOR CAFFERY PKWY | ||||||||
| Address2: | BLDG F, SUITE 600 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705086962 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 213 FOURPARK RD STE C | ||||||||
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| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705072481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378966400 | ||||||||
| FaxNumber: | 3378966441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFITH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3373545231 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 9685 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.