Provider Demographics
NPI:1093813826
Name:GREER, MARTIN GLENN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GLENN
Last Name:GREER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5327
Mailing Address - Country:US
Mailing Address - Phone:505-522-5466
Mailing Address - Fax:505-521-8611
Practice Address - Street 1:1395 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5327
Practice Address - Country:US
Practice Address - Phone:505-522-5466
Practice Address - Fax:505-521-8611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM415103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling