Provider Demographics
NPI:1649065954
Name:GREENE, KIRA
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:GREENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2508
Mailing Address - Country:US
Mailing Address - Phone:435-219-2811
Mailing Address - Fax:
Practice Address - Street 1:390 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2508
Practice Address - Country:US
Practice Address - Phone:435-219-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician