Provider Demographics
NPI:1306389762
Name:GREESON, KELLE (LPCC, CWC)
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:
Last Name:GREESON
Suffix:
Gender:F
Credentials:LPCC, CWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 MAGLY CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2841
Mailing Address - Country:US
Mailing Address - Phone:513-404-1144
Mailing Address - Fax:
Practice Address - Street 1:43 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1993
Practice Address - Country:US
Practice Address - Phone:513-947-7021
Practice Address - Fax:513-947-7001
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 1200061101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor