Healthcare Provider Details

I. General information

NPI: 1780484337
Provider Name (Legal Business Name): THE GREENHOUSE AFFECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 BELLASOL CIR APT 824
FORT MYERS FL
33916-7341
US

IV. Provider business mailing address

4214 BELLASOL CIR APT 824
FORT MYERS FL
33916-7341
US

V. Phone/Fax

Practice location:
  • Phone: 239-878-6998
  • Fax:
Mailing address:
  • Phone: 239-878-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JALISA GREEN
Title or Position: CEO
Credential: LMHC
Phone: 239-878-6998