MEDICARE: ERIC J GREENE MFTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI0543	NV

General Provider Information

NPI Number	:	1538579164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC J GREENE MFTI

Provider Business Mailing Address
First Line	:	9051 ECHELON POINT DR UNIT 4014
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3224
Country	:	US
Telephone Number	:	702-395-1650
Fax Number	:

Provider Business Practice Location Address
First Line	:	9051 ECHELON POINT DR UNIT 3011
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3222
Country	:	US
Telephone Number	:	702-395-1650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	03/30/2016

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Directions to “ ERIC J GREENE MFTI” Practice Location

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