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NPI Code Detail

MEDICARE: DR. RICHARD GREVENGOED L.C.P.C.

MEDICARE: DR. RICHARD GREVENGOED L.C.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1803926IL
2101YP2500XProfessional Counselor1803926IN

General Provider Information

NPI Number : 1386770238
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD GREVENGOED L.C.P.C.
Provider Business Mailing Address
First Line : 559. E.161ST PLACE
Second Line :
City : SOUTH HOLLAND
State : IL
Zip : 60473
Country : US
Telephone Number : 708-474-6211
Fax Number :
Provider Business Practice Location Address
First Line : 559 E 161ST PL
Second Line :
City : SOUTH HOLLAND
State : IL
Zip : 60473-1618
Country : US
Telephone Number : 708-474-6211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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Directions to “ DR. RICHARD GREVENGOED L.C.P.C.” Practice Location

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