MEDICARE: MS. GINA MARIE GREATENS M.S., LMFT

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	719-124	WI

General Provider Information

NPI Number	:	1750345021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA MARIE GREATENS M.S., LMFT

Provider Business Mailing Address
First Line	:	909 CHERRY ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4823
Country	:	US
Telephone Number	:	920-680-5453
Fax Number	:	920-884-8181

Provider Business Practice Location Address
First Line	:	909 CHERRY ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4823
Country	:	US
Telephone Number	:	920-680-5453
Fax Number	:	920-884-8181

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	08/27/2020

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