Provider Demographics
NPI:1174829550
Name:GREENE, DAVID (QMHP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SW CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2645
Mailing Address - Country:US
Mailing Address - Phone:856-430-5041
Mailing Address - Fax:
Practice Address - Street 1:2021 SW CUSTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2645
Practice Address - Country:US
Practice Address - Phone:856-430-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health