Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 99048259A | IN |
N | 102L00000X | Psychologist | 99048259A | IN |
N | 103T00000X | Psychologist | 99048259A | IN |
N | 103TA0700X | Adult Development & Aging Psychologist | 99048259A | IN |
Y | 103G00000X | Clinical Psychologist | 99048259A | IN |
Y | 103TC0700X | Clinical Psychologist | 99048259A | IN |
N | 103TH0004X | Health Psychologist | 99048259A | IN |
N | 103TR0400X | Rehabilitation Psychologist | 99048259A | IN |
NPI | 1467731836 |
---|---|
Provider Name | Ms. Theresa Marie Greenlee |
First Address | Greenwood, IN 46143-1953 |
Second Address | Greenwood, IN 46143-1953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 29/11/2016 |