| Greengate Neurobehavioral Health Inc | |
|
19 N 5th Ave Beech Grove IN 46107-1325 | |
| (937) 776-5012 | |
| Not Available |
| Full Name | Greengate Neurobehavioral Health Inc |
|---|---|
| Speciality | Psychologist |
| Location | 19 N 5th Ave, Beech Grove, Indiana |
| Authorized Official Name and Position | Theresa Greenlee (OWNER) |
| Authorized Official Contact | 9377765012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greengate Neurobehavioral Health Inc 19 N 5th Ave Beech Grove IN 46107-1325 Ph: (937) 776-5012 | Greengate Neurobehavioral Health Inc 19 N 5th Ave Beech Grove IN 46107-1325 Ph: (937) 776-5012 |
| NPI Number | 1881276434 |
|---|---|
| Provider Enumeration Date | 04/23/2021 |
| Last Update Date | 04/23/2021 |
| Certification Date | 04/23/2021 |
| Medicare PECOS PAC ID | 0547655631 |
|---|---|
| Medicare Enrollment ID | O20220329000618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881276434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Theresa Marie Greenlee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467731836 PECOS PAC ID: 2163696006 Enrollment ID: I20111110000864 |
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