=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518347137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREELEY COUNSELING SERVICES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2015
-----------------------------------------------------
Last Update Date | 06/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 E LIBERTY ST
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29745-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-818-8257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 KINGS MOUNTAIN ST
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29745-1168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-818-8257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAUL WILLIAM GREELEY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 803-818-8257
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5754
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------