Gwendolyn Terese Greene

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MI0633 Issued in NV

Practice address

1649 West Horizon Ridge Parkway
Suite 130
Henderson, NV 89052-5080

Phone

(702) 930-5958

Fax

(702) 796-9490

NPI assigned

Jan 26, 2016

Last updated

Jan 26, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Renaissance Behavioral Health LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Las Vegas, NV
  • NPI 1760950927
  NPD Authorized official
• Renaissance Mental Health Corporation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Las Vegas, NV
  • NPI 1881295848
  NPD Authorized official
• Beryl Behavioral LLC

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1558103531
  NPD (past)
• Individualized Mindful Solutions LLC

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1669245239
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453766400000",
    "number": "1609233329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 620251",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891620251",
            "telephone_number": "702-930-5958",
            "fax_number": "702-796-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1649 WEST HORIZON RIDGE PARKWAY",
            "address_2": "SUITE 130",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525080",
            "telephone_number": "702-930-5958",
            "fax_number": "702-796-9490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "GWENDOLYN",
        "middle_name": "TERESE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-26",
        "last_updated": "2016-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NV",
            "license": "MI0633",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NV",
            "license": "MI0633",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myeangel Green
• Raynesha Green
• Thomas Jefferson Green, CRNA
• Tonyetta Green
• Bradley Stephen Greenbaum, M.D.
• Ke-Yara Greene, RBT
• Ryan M Greenwood, CPC
• Susan Gregersen
• Odessa Gregorio, RN
• Kam-Lin D Gregory, APRN-CNM

• Marriage & Family Therapist in Henderson, NV
• Providers in Henderson, NV by specialty
• Marriage & Family Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.