Healthcare Provider Details

I. General information

NPI: 1023325834
Provider Name (Legal Business Name): T. GREENE MANAGEMENT COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S LEXINGTON WAY
EDMOND OK
73012-4221
US

IV. Provider business mailing address

109 S LEXINGTON WAY
EDMOND OK
73012-4221
US

V. Phone/Fax

Practice location:
  • Phone: 405-513-6901
  • Fax: 405-285-9074
Mailing address:
  • Phone: 405-513-6901
  • Fax: 405-285-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3311
License Number StateOK

VIII. Authorized Official

Name: MS. TERESA WASHINGTON GREENE
Title or Position: CEO
Credential: M.ED. LPC
Phone: 405-657-9236