MEDICARE: KASSIDY NOELLE GREAVES M.A., LPC

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
1	101YM0800X	Mental Health Counselor	92092	TX

General Provider Information

NPI Number	:	1588599641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSIDY NOELLE GREAVES M.A., LPC

Provider Business Mailing Address
First Line	:	5213 46TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-1509
Country	:	US
Telephone Number	:	806-831-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 46TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-1509
Country	:	US
Telephone Number	:	806-831-1843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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