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General NPI Number Information
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NPI Number | 1174927024
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Entity Type | Organization
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Legal Business Name | GREEN ROOTS COUNSELING
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 423 PACIFIC AVE
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City | BREMERTON
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State | WA
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Zip | 98337-1914
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Country | US
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Telephone | 360-471-2953
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Fax |
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Provider Business Mailing Address
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Address Line | 1537 MORGAN RD NW
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City | BREMERTON
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State | WA
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Zip | 98312-2626
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Country | US
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Telephone | 360-471-2953
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | JENNIFER L HENSLEY
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Credential |
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Telephone | 360-471-2953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC 60323887
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License Number State | WA
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