Healthcare Provider Details

I. General information

NPI: 1760549976
Provider Name (Legal Business Name): GREEN COUNTRY BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E SKELLY DR STE 115
TULSA OK
74105-6344
US

IV. Provider business mailing address

619 N MAIN ST
MUSKOGEE OK
74401-4431
US

V. Phone/Fax

Practice location:
  • Phone: 918-665-0208
  • Fax: 918-687-0976
Mailing address:
  • Phone: 918-682-8407
  • Fax: 918-687-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK BRIAN JOHNSON
Title or Position: IT DIRECTOR
Credential:
Phone: 918-682-8407