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Jenise Tehvon Greene

Counselor

Behavioral Health & Social Service Providers

1808 Over Lake Dr SE Ste D, Conyers, GA 30013-6608

PECOS Enrollment

This provider is enrolled in PECOS as JENISE GREENE.

Based on the most recent information from CMS, provider Jenise Tehvon Greene is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 11:51 AM.

Profile Details

Provider ID
1255042495
Provider Type
Individual
Full Name
Greene, Jenise Tehvon
Gender
Female

Sole Proprietor
Yes
Enumeration Date
12/8/2022
Last Updated
2/16/2023

Contact Information

Practice Location

1808 Over Lake Dr SE Ste D, Conyers, GA 30013-6608

(678) 213-2194

Unlisted Fax

Mailing Location

1808 Over Lake Dr SE Ste D, Conyers, GA 30013-6608

(404) 273-8504

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YP2500X Primary	Description Counselor Behavioral Health & Social Service Providers	License LPC013548 Georgia

Jenise Tehvon Greene

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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