Basic Information
Provider Information
NPI: 1124646534
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GREEK
FirstName: MILTON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PSY-A
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 188
Address2:  
City: CHILLICOTHE
State: OH
PostalCode: 456010188
CountryCode: US
TelephoneNumber: 7407734366
FaxNumber: 7407757855
Practice Location
Address1: 90 HOSPITAL DR
Address2:  
City: ATHENS
State: OH
PostalCode: 457012301
CountryCode: US
TelephoneNumber: 7405923091
FaxNumber: 7407733985
Other Information
ProviderEnumerationDate: 07/13/2020
LastUpdateDate: 10/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  N Behavioral Health & Social Service ProvidersCounselorMental Health
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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