Healthcare Provider Details

I. General information

NPI: 1831603844
Provider Name (Legal Business Name): GREEN HOUSE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6617 HIDDEN HICKORY CIR
COLO SPGS CO
80927-4048
US

IV. Provider business mailing address

6617 HIDDEN HICKORY CIR
COLO SPGS CO
80927-4048
US

V. Phone/Fax

Practice location:
  • Phone: 719-648-9490
  • Fax:
Mailing address:
  • Phone: 719-648-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11804
License Number StateCO

VIII. Authorized Official

Name: MRS. ASHTIN TAYLOR GREEEN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 719-648-9490