Healthcare Provider Details

I. General information

NPI: 1457186892
Provider Name (Legal Business Name): GREEN MOUNTAIN BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 COLD SPRINGS RD
GETTYSBURG PA
17325-7334
US

IV. Provider business mailing address

440 EISENHOWER DR # 1036
HANOVER PA
17331-5221
US

V. Phone/Fax

Practice location:
  • Phone: 571-620-8200
  • Fax:
Mailing address:
  • Phone: 717-389-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TARYN WALKER
Title or Position: OWNER
Credential: PSYD
Phone: 717-389-1222