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NPI Code Detail

MEDICARE: GARY LEE GREENE LPC

MEDICARE: GARY LEE GREENE 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
1101YP2500XProfessional Counselor4126LA
2101YP2500XProfessional Counselor4343GA

General Provider Information

NPI Number : 1700057460
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY LEE GREENE LPC
Provider Business Mailing Address
First Line : 10 WILSON RD
Second Line :
City : STOCKBRIDGE
State : GA
Zip : 30281-4468
Country : US
Telephone Number : 770-506-9575
Fax Number : 770-506-9369
Provider Business Practice Location Address
First Line : 7200 DESIARD ST
Second Line :
City : MONROE
State : LA
Zip : 71203-3913
Country : US
Telephone Number : 318-345-8200
Fax Number : 318-342-8049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2008
Last Update Date : 05/04/2009

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Directions to “ GARY LEE GREENE LPC” Practice Location

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