Provider Demographics
NPI:1124176318
Name:GREENHOUSE, ELLEN M (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:GREENHOUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4122
Mailing Address - Country:US
Mailing Address - Phone:303-447-0141
Mailing Address - Fax:303-402-0677
Practice Address - Street 1:2315 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4122
Practice Address - Country:US
Practice Address - Phone:303-447-0141
Practice Address - Fax:303-402-0677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1836Medicare ID - Type Unspecified