Healthcare Provider Details

I. General information

NPI: 1306031422
Provider Name (Legal Business Name): MICHELLE GREENWOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NORTH AVE 116
GRAND JUNCTION CO
81501-6428
US

IV. Provider business mailing address

2121 NORTH AVE 116
GRAND JUNCTION CO
81501-6428
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-2800
  • Fax:
Mailing address:
  • Phone: 970-263-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6325
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09926437
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: