Provider Demographics
NPI:1467731836
Name:GREENLEE, THERESA MARIE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARIE
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:GREENLEE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:494 S EMERSON AVE
Mailing Address - Street 2:STE C
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1953
Mailing Address - Country:US
Mailing Address - Phone:937-776-5012
Mailing Address - Fax:317-889-3902
Practice Address - Street 1:494 S EMERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1953
Practice Address - Country:US
Practice Address - Phone:937-776-5012
Practice Address - Fax:317-889-3902
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99048259A103K00000X, 103T00000X, 103TA0700X, 103TC0700X, 103TH0004X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation