Provider Demographics
NPI:1497937049
Name:GREENE, MICHAEL T (MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:GREENE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E LINCOLN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6901
Mailing Address - Country:US
Mailing Address - Phone:509-701-4320
Mailing Address - Fax:208-439-8277
Practice Address - Street 1:111 E LINCOLN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6901
Practice Address - Country:US
Practice Address - Phone:509-701-4320
Practice Address - Fax:208-439-8277
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health