Provider Demographics
NPI:1093203242
Name:GREENE, HILARY ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:ANN
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18584 TROTT BROOK PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4662
Mailing Address - Country:US
Mailing Address - Phone:763-213-3763
Mailing Address - Fax:
Practice Address - Street 1:501 4TH ST S STE 201
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-4754
Practice Address - Country:US
Practice Address - Phone:763-309-1005
Practice Address - Fax:763-374-2000
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist