Provider Demographics
NPI:1154710176
Name:GREENWELL, MICHAEL N (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:GREENWELL
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3422
Mailing Address - Country:US
Mailing Address - Phone:602-323-3345
Mailing Address - Fax:602-323-3399
Practice Address - Street 1:3522 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3903
Practice Address - Country:US
Practice Address - Phone:602-776-7676
Practice Address - Fax:602-776-3002
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-151991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-15199OtherLICENSE #