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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
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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