Provider Demographics
NPI:1184274334
Name:GREIG, BRENDA SUE (LADC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:GREIG
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 W 78TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4528
Mailing Address - Country:US
Mailing Address - Phone:612-567-8817
Mailing Address - Fax:
Practice Address - Street 1:480 W 78TH ST STE 111
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4528
Practice Address - Country:US
Practice Address - Phone:612-567-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304668101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)