Provider Demographics
NPI:1114563905
Name:MARY JO GREENWOOD LCSW
Entity Type:Organization
Organization Name:MARY JO GREENWOOD LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-710-0503
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0568
Mailing Address - Country:US
Mailing Address - Phone:307-326-5566
Mailing Address - Fax:
Practice Address - Street 1:106 N. RIVER STREET
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-8233
Practice Address - Country:US
Practice Address - Phone:307-710-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty