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General NPI Number Information
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NPI Number | 1821933011
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Entity Type | Organization
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Legal Business Name | GREEN PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 1005 WILD WILLOW WAY # 122
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City | VERONA
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State | WI
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Zip | 53593-1223
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Country | US
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Telephone | 608-891-1526
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E VERONA AVE # 1075
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City | VERONA
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State | WI
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Zip | 53593-1223
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Country | US
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Telephone | 608-891-1526
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS ROBERT GREEN
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Credential | LPC
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Telephone | 608-891-1526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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