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NPI Code Detail

MEDICARE: MS. LYNNETTE GREAK M.ED., L.P.C.

MEDICARE: MS. LYNNETTE GREAK M.ED., L.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 Counselor15242TX

General Provider Information

NPI Number : 1720184484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LYNNETTE GREAK M.ED., L.P.C.
Provider Business Mailing Address
First Line : 3223 S LOOP 289
Second Line : SUITE 240-U
City : LUBBOCK
State : TX
Zip : 79423-1337
Country : US
Telephone Number : 806-794-4261
Fax Number : 800-462-4189
Provider Business Practice Location Address
First Line : 3223 S LOOP 289
Second Line : SUITE 240-U
City : LUBBOCK
State : TX
Zip : 79423-1337
Country : US
Telephone Number : 806-794-4261
Fax Number : 800-462-4189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 07/09/2007

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