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Organization
THE GRIFFIN PROMISE
Active
Organization
THE GRIFFIN PROMISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI FREDERICK (EXECUTIVE DIRECTOR)
(918) 893-3735
Entity
Organization
Contact information
Practice address
3100 S ELM PL STE A, BROKEN ARROW, OK 74012-7950
(918) 893-3735
(918) 893-3745
Mailing address
3100 S ELM PL STE A, BROKEN ARROW, OK 74012-7950
(918) 893-3735
(918) 893-3745
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
NULL
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
235Z00000X
Speech-Language Pathologist
Primary
2767
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200536910A
—
OK
Enumeration date
01/29/2014
Last updated
09/26/2024
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