Provider Demographics
NPI:1801596655
Name:GREENWELL, EVA (MA, LPC)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 COUNTY ROAD 267
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6832
Mailing Address - Country:US
Mailing Address - Phone:815-674-7882
Mailing Address - Fax:
Practice Address - Street 1:690 COUNTY ROAD 267
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6832
Practice Address - Country:US
Practice Address - Phone:815-674-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86419101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional