Provider Demographics
NPI:1265260913
Name:GREENE, BRYNN
Entity type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 S 4TH ST RM 212
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2115
Mailing Address - Country:US
Mailing Address - Phone:270-889-7807
Mailing Address - Fax:
Practice Address - Street 1:851 S 4TH ST RM 212
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2115
Practice Address - Country:US
Practice Address - Phone:270-889-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health