Provider Information for 1104113885
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STACI GREENAWAY LMFT
Sex: Female
NPI: 1104113885
Last Updated: 2024-11-14
Certification Date: 2024-11-14
Certification Date: 2024-11-14
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104113885 | ||||||||
| Enumeration Date | 2011-07-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 45555 VIA JACA TEMECULA, CA 92592-1307 United States Phone: 951-204-5812 | Fax: | ||||||||
| Primary Practice Address | 45555 VIA JACA TEMECULA, CA 92592-1307 United States Phone: 951-204-5812 | Fax: | ||||||||
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