Organization
GREENLEAF PSYCHOLOGY
Active
Organization
GREENLEAF PSYCHOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY CHARBONEAU EDD, QEEG, BCN, BCB (LICENSED NEUROPSYCHOLOGIST)
(509) 838-8066
Entity
Organization
Contact information
Practice address
3157 E 17TH AVE, SPOKANE, WA 99223-5136
(509) 838-8066
(800) 594-8305
Mailing address
3157 E 17TH AVE, SPOKANE, WA 99223-5136
(509) 838-8066
(800) 594-8305
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
PY00002046
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790773463
INDIVIDUAL NPI
WA
Enumeration date
07/29/2016
Last updated
07/29/2016
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