=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548699630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. GENA CHRISTINE GREATHOUSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2013
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 ABC LN
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75551-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-796-7164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 COUNTY ROAD 4809
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75551-8512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-799-8983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 113559
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 5250
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------