Provider Demographics
NPI:1487328043
Name:DOUGLAS- GRIFFIN, JO ELLEN
Entity type:Individual
Prefix:MRS
First Name:JO
Middle Name:ELLEN
Last Name:DOUGLAS- GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44920 13TH ST E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1104
Mailing Address - Country:US
Mailing Address - Phone:661-494-9385
Mailing Address - Fax:
Practice Address - Street 1:23824 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5935
Practice Address - Country:US
Practice Address - Phone:310-791-3064
Practice Address - Fax:310-791-3084
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA131808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program