Provider Demographics
NPI:1689626335
Name:GREULING, JACQUELIN WREN (PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:WREN
Last Name:GREULING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JACQUELIN
Other - Middle Name:CLYMER
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3115 LOOP 306
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5983
Mailing Address - Country:US
Mailing Address - Phone:325-942-1952
Mailing Address - Fax:325-942-1517
Practice Address - Street 1:3115 LOOP 306
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5983
Practice Address - Country:US
Practice Address - Phone:325-942-1952
Practice Address - Fax:325-942-1517
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179188102Medicaid
TX179188102Medicaid