Provider Demographics
NPI:1437427671
Name:GREENWELL, RIETA BARRETT (PMHP)
Entity Type:Individual
Prefix:MRS
First Name:RIETA
Middle Name:BARRETT
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:PMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1450
Mailing Address - Country:US
Mailing Address - Phone:402-558-3856
Mailing Address - Fax:
Practice Address - Street 1:4535 LEAVENWORTH ST STE 4
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1453
Practice Address - Country:US
Practice Address - Phone:402-558-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health