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NPI Code Detail

MEDICARE: GREEN HOUSE GROUP PA

MEDICARE: GREEN HOUSE GROUP PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist512NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326256611
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREEN HOUSE GROUP PA
Provider Business Mailing Address
First Line : 250 COMMERCIAL STREET
Second Line : SUITE 3004
City : MANCHESTER
State : NH
Zip : 03101
Country : US
Telephone Number : 603-668-3050
Fax Number : 603-668-8666
Provider Business Practice Location Address
First Line : 250 COMMERCIAL STREET
Second Line : SUITE 3004
City : MANCHESTER
State : NH
Zip : 03101-1118
Country : US
Telephone Number : 603-668-3050
Fax Number : 603-668-8666
Authorized Official
Title or Position : VICE PRESIDENT
Name : MELISSA WALLACE
Credential : PSYD
Telephone Number : 603-668-3050
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/10/2023

Similar Medicare Providers

1801812839 — DR. DOUGLAS B. JOHNSON PSY.D.
Practice Location Address:
250 COMMERCIAL STREET , SUITE 3004
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1336258318 — RENE OUELLET LICSW
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1417050972 — JAMES B. HALLA PSY.D.
Practice Location Address:
250 COMMERCIAL STREET , SUITE 3004
MANCHESTER, NH
03101-1118
Practice Phone: 603-668-3050
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1235216482 — DR. MELISSA M. WALLACE PSY.D.
Practice Location Address:
250 COMMERCIAL STREET , SUITE 3004
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03101-1118
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Practice Fax: 603-668-8666
1841367166 — J. DAVID RENOUF LCMHC
Practice Location Address:
250 COMMERCIAL STREET , SUITE 3004
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1144371949 — ERLINE TOWNER LCMHC
Practice Location Address:
250 COMMERCIAL STREET , SUITE 3004
MANCHESTER, NH
03101-1118
Practice Phone: 603-668-3050
Practice Fax: 603-668-8666

Directions to “GREEN HOUSE GROUP PA ” Practice Location

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