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General NPI Number Information
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NPI Number | 1104889401
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Entity Type | Organization
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Legal Business Name | JACK GREESON PHD & ASSOCIATES PC
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5606 N NAVARRO STE 209
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City | VICTORIA
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State | TX
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Zip | 77904
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Country | US
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Telephone | 361-578-9190
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Fax | 361-578-9206
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Provider Business Mailing Address
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Address Line | PO BOX 4953
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City | VICTORIA
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State | TX
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Zip | 77903
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Country | US
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Telephone | 361-578-9190
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Fax | 361-578-9206
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Authorized Official
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Title or Position | PSYCHOLOGIST PRESIDENT
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Name | JACK GREESON
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Credential | PHD
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Telephone | 361-578-9190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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