MEDICARE: THORA GREAVES LMSW

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	6801077510	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639385263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THORA GREAVES LMSW

Provider Business Mailing Address
First Line	:	107 WATER ST
Second Line	:	SUITE #206
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-3451
Country	:	US
Telephone Number	:	269-861-5084
Fax Number	:	269-934-0557

Provider Business Practice Location Address
First Line	:	107 WATER ST
Second Line	:	SUITE #206
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-3451
Country	:	US
Telephone Number	:	269-861-5084
Fax Number	:	269-934-0557

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/25/2016

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Directions to “ THORA GREAVES LMSW” Practice Location

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