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General NPI Number Information
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NPI Number | 1427571637
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Entity Type | Organization
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Legal Business Name | GREEN VALLEY THERAPY
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1070 W HORIZON RIDGE PKWY STE 210
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City | HENDERSON
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State | NV
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Zip | 89012-6020
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Country | US
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Telephone | 702-219-7597
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 W HORIZON RIDGE PKWY STE 210
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City | HENDERSON
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State | NV
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Zip | 89012-6020
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Country | US
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Telephone | 702-219-7597
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER K PIETRZAK
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Credential | LCSW
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Telephone | 702-219-7597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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