Provider Demographics
NPI:1366992695
Name:MANY ROADS CLINIC
Entity type:Organization
Organization Name:MANY ROADS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, LPC, CSAC
Authorized Official - Phone:414-975-8106
Mailing Address - Street 1:4540 S HEARTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-6578
Mailing Address - Country:US
Mailing Address - Phone:414-975-8106
Mailing Address - Fax:
Practice Address - Street 1:2510 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2136
Practice Address - Country:US
Practice Address - Phone:414-975-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15410-132101YA0400X
WI4100-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty