Provider Demographics
NPI:1104275353
Name:JENNIFER LYNN GREENUP
Entity type:Organization
Organization Name:JENNIFER LYNN GREENUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GREENUP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-247-3901
Mailing Address - Street 1:PO BOX 51364
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-1364
Mailing Address - Country:US
Mailing Address - Phone:307-247-3901
Mailing Address - Fax:888-659-0934
Practice Address - Street 1:330 S CENTER ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2840
Practice Address - Country:US
Practice Address - Phone:307-277-6473
Practice Address - Fax:888-659-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty