Provider Demographics
NPI:1457812885
Name:GREENLEAF, BRIAN NEAL (CADC II)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:NEAL
Last Name:GREENLEAF
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44359 PALM ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3116
Mailing Address - Country:US
Mailing Address - Phone:760-342-6616
Mailing Address - Fax:760-342-8073
Practice Address - Street 1:44359 PALM ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3116
Practice Address - Country:US
Practice Address - Phone:760-342-6616
Practice Address - Fax:760-342-8073
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063790224101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881788503OtherMEDI-CAL