Provider Demographics
NPI:1396775235
Name:GREENSPON, THOMAS STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:GREENSPON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16325
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-0325
Mailing Address - Country:US
Mailing Address - Phone:952-929-1499
Mailing Address - Fax:952-929-6097
Practice Address - Street 1:3601 PARK CENTER BLVD
Practice Address - Street 2:SUITE 128
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-2531
Practice Address - Country:US
Practice Address - Phone:952-929-1499
Practice Address - Fax:952-929-6097
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1944103T00000X
MN0150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist