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General NPI Number Information
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NPI Number | 1326256611
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Entity Type | Organization
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Legal Business Name | GREEN HOUSE GROUP PA
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 250 COMMERCIAL STREET SUITE 3004
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City | MANCHESTER
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State | NH
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Zip | 03101-1118
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Country | US
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Telephone | 603-668-3050
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Fax | 603-668-8666
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Provider Business Mailing Address
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Address Line | 250 COMMERCIAL STREET SUITE 3004
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City | MANCHESTER
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State | NH
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Zip | 03101
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Country | US
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Telephone | 603-668-3050
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Fax | 603-668-8666
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MELISSA WALLACE
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Credential | PSYD
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Telephone | 603-668-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 512
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License Number State | NH
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