| Doctor Name: | GREG MUCKLOW |
| NPI Number: | 1063721355 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS |
| License Number: | 969 |
| Business Practice Address: | 3810 Central Ave Kearney, NE - 688478134 |
| Business Phone Number: | 3082375951 |
| Business Fax Number: | |
| Mailing Address: | 3810 Central Ave, KEARNEY |
| State: | NE |
| Postal Code: | 688478134 |
| Phone Number: | 3082375951 |
| Fax Number: | |
| NPI Enumeration Date: | 10/04/2010 |
| NPI Last Update Date: | 07/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 969 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |