Provider Demographics
NPI:1619539442
Name:MEGAN GREENE COUNSELING, LLC
Entity Type:Organization
Organization Name:MEGAN GREENE COUNSELING, LLC
Other - Org Name:MEGAN GREENE COUNSELING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:989-600-6239
Mailing Address - Street 1:3215 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5850
Mailing Address - Country:US
Mailing Address - Phone:989-600-6239
Mailing Address - Fax:
Practice Address - Street 1:2539 N KEDZIE BLVD STE 5E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1435
Practice Address - Country:US
Practice Address - Phone:872-903-3829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1316473069OtherBLUE CROSS BLUE SHIELD