Provider Demographics
NPI:1548312101
Name:GREENWOOD, MICHAEL RAY (MSSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13121 HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7424
Mailing Address - Country:US
Mailing Address - Phone:512-250-8500
Mailing Address - Fax:512-258-1166
Practice Address - Street 1:1717 W 6TH ST
Practice Address - Street 2:#234
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4773
Practice Address - Country:US
Practice Address - Phone:512-791-1127
Practice Address - Fax:512-258-1166
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical