Healthcare Provider Details

I. General information

NPI: 1891569687
Provider Name (Legal Business Name): AARON TYLER GREENWELL MA, LLPC, SCL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4576 W WALTON BLVD
WATERFORD MI
48329-4905
US

IV. Provider business mailing address

53465 GARLAND DR
SHELBY TOWNSHIP MI
48316-2728
US

V. Phone/Fax

Practice location:
  • Phone: 248-618-3920
  • Fax:
Mailing address:
  • Phone: 248-390-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: