Provider Demographics
NPI:1578247581
Name:GREENOUGH, ANTHONY JAMES
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:GREENOUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3667 SHANLEY RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9558
Mailing Address - Country:US
Mailing Address - Phone:989-906-5388
Mailing Address - Fax:
Practice Address - Street 1:910 SPRING ST STE 4
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2881
Practice Address - Country:US
Practice Address - Phone:231-268-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician