Provider Demographics
NPI:1083700082
Name:GREENE, WILLIE LEE SR (MA, MCJ)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:LEE
Last Name:GREENE
Suffix:SR
Gender:M
Credentials:MA, MCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5207 WHISTLE STOP DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7675
Mailing Address - Country:US
Mailing Address - Phone:254-899-2702
Mailing Address - Fax:254-743-1855
Practice Address - Street 1:1901 S 1ST STREET
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-2920
Practice Address - Fax:254-743-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)