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General NPI Number Information
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NPI Number | 1801026935
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Entity Type | Organization
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Legal Business Name | GREENTREE COUNSELING LLC
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 160 E GENEVA SQ
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City | LAKE GENEVA
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State | WI
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Zip | 53147-9694
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Country | US
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Telephone | 262-249-0830
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Fax | 262-249-0835
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | ZENDA
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State | WI
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Zip | 53195-0100
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Country | US
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Telephone | 262-249-0830
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Fax | 262-249-0835
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Authorized Official
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Title or Position | OWNER
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Name | MR. CRAIG ALAN LUEBKE
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Credential | MSW, LCSW
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Telephone | 262-249-0830
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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 | 3556-123
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License Number State | WI
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