Provider Demographics
NPI:1669873378
Name:SMYLIE, GRETA (MA)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:SMYLIE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15568 DANBURY AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4659
Mailing Address - Country:US
Mailing Address - Phone:218-341-9208
Mailing Address - Fax:
Practice Address - Street 1:4660 SLATER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4047
Practice Address - Country:US
Practice Address - Phone:651-882-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health