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General NPI Number Information
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NPI Number | 1801925193
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Entity Type | Organization
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Legal Business Name | GREEN DOOR BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 1221 TAYLOR ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5617
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Country | US
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Telephone | 202-464-9200
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Fax | 202-464-5740
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Provider Business Mailing Address
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Address Line | 1221 TAYLOR ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5617
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Country | US
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Telephone | 202-464-9200
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Fax | 202-464-5740
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Authorized Official
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Title or Position | CEO
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Name | MR. RICHARD BEBOUT
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Credential | PH.D.
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Telephone | 202-464-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 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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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 54000690
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License Number State | DC
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | DC
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Taxonomy #7
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | DC
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