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General NPI Number Information
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NPI Number | 1447821293
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Entity Type | Organization
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Legal Business Name | GREEN COUNTRY MENTAL HEALTH & THERAPEUTIC SERVICES, PLC
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 4325 E 51ST ST STE 102
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City | TULSA
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State | OK
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Zip | 74135-3646
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Country | US
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Telephone | 539-302-9192
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Fax |
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Provider Business Mailing Address
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Address Line | 5914 S 130TH WEST AVE
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City | SAND SPRINGS
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State | OK
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Zip | 74063-2391
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Country | US
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Telephone | 539-323-0125
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. JEFFERY ALLAN WILSON
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Credential | MS, LPC-S, RPT
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Telephone | 539-323-0125
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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 |
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License Number State |
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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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