Provider Demographics
NPI:1629289210
Name:GREENWOOD, GREG THOMAS (PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:THOMAS
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7286 SOUTHAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-8540
Mailing Address - Country:US
Mailing Address - Phone:513-895-1961
Mailing Address - Fax:513-895-1554
Practice Address - Street 1:7286 SOUTHAMPTON LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-8540
Practice Address - Country:US
Practice Address - Phone:513-895-1961
Practice Address - Fax:513-895-1554
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040003103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical