Provider Demographics
NPI:1982266607
Name:GREKIN, REBECCA SHAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SHAYNE
Last Name:GREKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 REDROCK CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9095
Mailing Address - Country:US
Mailing Address - Phone:808-778-8930
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD STE 210
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9559
Practice Address - Country:US
Practice Address - Phone:734-249-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017867103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist