Provider Demographics
NPI:1538579164
Name:GREENE, ERIC J (MFTI)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:GREENE
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 ECHELON POINT DR UNIT 4014
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3224
Mailing Address - Country:US
Mailing Address - Phone:702-395-1650
Mailing Address - Fax:
Practice Address - Street 1:9051 ECHELON POINT DR UNIT 3011
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3222
Practice Address - Country:US
Practice Address - Phone:702-395-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist