Provider Demographics
NPI:1134419179
Name:GREENE, KAREN GRIFFITH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:GRIFFITH
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 W ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:IL
Mailing Address - Zip Code:61528-9699
Mailing Address - Country:US
Mailing Address - Phone:309-370-3916
Mailing Address - Fax:
Practice Address - Street 1:7617 N VILLA WOOD LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1588
Practice Address - Country:US
Practice Address - Phone:309-693-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional