Provider Demographics
NPI:1770300287
Name:GREENE, MYRNA JOY
Entity type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:JOY
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 1:7900 US HIGHWAY 50 # A
Mailing Address - Street 2:
Mailing Address - City:SHOALS
Mailing Address - State:IN
Mailing Address - Zip Code:47581-2278
Mailing Address - Country:US
Mailing Address - Phone:812-247-2085
Mailing Address - Fax:
Practice Address - Street 1:7900 US HIGHWAY 50 # A
Practice Address - Street 2:
Practice Address - City:SHOALS
Practice Address - State:IN
Practice Address - Zip Code:47581-2278
Practice Address - Country:US
Practice Address - Phone:812-247-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1620432103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool