Provider Demographics
NPI:1952095887
Name:GREYSTONE, MAGNUS
Entity type:Individual
Prefix:
First Name:MAGNUS
Middle Name:
Last Name:GREYSTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:GREYSTONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14301 EWING AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4885
Mailing Address - Country:US
Mailing Address - Phone:952-746-5350
Mailing Address - Fax:
Practice Address - Street 1:14301 EWING AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4885
Practice Address - Country:US
Practice Address - Phone:952-746-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician