Individual
MICHELLE MARIE GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1653 W CONGRESS PKWY, 245 RAWSON BUILDING, CHICAGO, IL 60612-3833
(312) 942-8598
Mailing address
2415 W LELAND AVE, APT #2, CHICAGO, IL 60625-3016
(312) 942-8598
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.007995
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071.007995
STATE OF ILLINOIS PSYCHOLOGY LICENSE
IL
Enumeration date
12/10/2010
Last updated
12/10/2010
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