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General NPI Number Information
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NPI Number | 1154773042
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Entity Type | Organization
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Legal Business Name | GREENE BEHAVIORAL HEALTH, INC.
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 10/30/2016
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Provider Practice Location Address
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Address Line | 701 S 11TH ST
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City | RICHMOND
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State | TX
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Zip | 77469-3361
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Country | US
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Telephone | 832-759-5496
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Fax | 832-847-4433
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Provider Business Mailing Address
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Address Line | 701 S 11TH ST
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City | RICHMOND
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State | TX
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Zip | 77469-3361
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Country | US
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Telephone | 832-759-5496
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Fax | 832-847-4433
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DAVID GREEN GAITHER
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Credential |
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Telephone | 832-759-5496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 62893
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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