MEDICARE: GREEN COUCH COUNSELING, 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1912839077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN COUCH COUNSELING, INC.

Provider Business Mailing Address
First Line	:	3470 S SHERMAN ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3470 S SHERMAN ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2680
Country	:	US
Telephone Number	:	720-779-0351
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MALLORY GOLLICK
Credential	:
Telephone Number	:	720-779-0351

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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