MEDICARE: GREEN HOUSE AND ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	103T00000X	Psychologist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA9104	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000291010	OTHER	IN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558316463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN HOUSE AND ASSOCIATES INC

Provider Business Mailing Address
First Line	:	PO BOX 361327
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-1327
Country	:	US
Telephone Number	:	317-253-7387
Fax Number	:	317-253-7388

Provider Business Practice Location Address
First Line	:	6246 W BROADWAY # 200
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055
Country	:	US
Telephone Number	:	317-253-7387
Fax Number	:	317-253-7388

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LAURA A HUDDLESTON
Credential	:
Telephone Number	:	317-253-7387

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/29/2019

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Directions to “GREEN HOUSE AND ASSOCIATES INC ” Practice Location

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