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General NPI Number Information
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NPI Number | 1104363068
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Entity Type | Individual
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Provider Name | MATTHEW GREENE (M.S.)
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Gender | Male
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 21448 N 75TH AVE STE 6
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 623-638-0138
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Fax |
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Provider Business Mailing Address
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Address Line | 12587 W GENTLE RAIN RD
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City | PEORIA
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State | AZ
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Zip | 85383-7226
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Country | US
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Telephone | 530-209-2142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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