Provider Demographics
NPI:1881276434
Name:GREENGATE NEUROBEHAVIORAL HEALTH INC
Entity type:Organization
Organization Name:GREENGATE NEUROBEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-776-5012
Mailing Address - Street 1:19 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1325
Mailing Address - Country:US
Mailing Address - Phone:937-776-5012
Mailing Address - Fax:
Practice Address - Street 1:19 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1325
Practice Address - Country:US
Practice Address - Phone:937-776-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty