=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922896943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENHOUSE THERAPY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2025
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 328 S CENTRAL AVE
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97501-7274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-395-9568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2654 LAWNVIEW DR
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97504-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-601-8180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | DANIELLE JOAN BROYLES
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 541-395-9568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------