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General NPI Number Information
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NPI Number | 1245780360
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Entity Type | Organization
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Legal Business Name | GREYHAWK COUNSELING SERVICES, LLC.
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 8141 STATE HIGHWAY 59 SUITE 3
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City | FOLEY
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State | AL
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Zip | 36535-3869
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Country | US
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Telephone | 251-200-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 6061 COLONIAL PKWY UNIT 6208
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City | GULF SHORES
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State | AL
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Zip | 36542-2575
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Country | US
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Telephone | 251-200-1567
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER/LICENSED PSYCHOTHERAPIST
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Name | MR. MARK WALTER UNDERWOOD
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Credential | LMFT
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Telephone | 251-200-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 437
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License Number State | AL
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