Basic Information
| Provider Information | |||||||||
| NPI: | 1689750440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREINER | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3106 50TH ST | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794134132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066988088 | ||||||||
| FaxNumber: | 8066988588 | ||||||||
| Practice Location | |||||||||
| Address1: | 3106 50TH ST | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794134132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066988088 | ||||||||
| FaxNumber: | 8066988588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S12962 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 114044100 | 01 | TX | FIRST CARE | OTHER | 87265Q | 01 | TX | BC/BS | OTHER | 0639692-03 | 05 | TX | MEDICAID | P00302165 | 01 | TX | RR MEDICARE | OTHER |