Provider Demographics
NPI:1508889056
Name:GREENWOOD, JOHN E (MED, LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-0146
Mailing Address - Country:US
Mailing Address - Phone:715-536-4440
Mailing Address - Fax:715-536-2736
Practice Address - Street 1:120 S MILL ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2534
Practice Address - Country:US
Practice Address - Phone:715-536-4440
Practice Address - Fax:715-536-2736
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2364-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional