Healthcare Provider Details

I. General information

NPI: 1679495600
Provider Name (Legal Business Name): GREENWOOD COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 E FAIRFIELD ST
MESA AZ
85205-5346
US

IV. Provider business mailing address

4910 E FAIRFIELD ST
MESA AZ
85205-5346
US

V. Phone/Fax

Practice location:
  • Phone: 602-812-2296
  • Fax:
Mailing address:
  • Phone: 602-812-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB LAYNE BROWN
Title or Position: MANAGING MEMBER
Credential: LPC
Phone: 602-812-2296