MEDICARE: GREENHOUSE PSYCHIATRIC SERVICES LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1669130621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENHOUSE PSYCHIATRIC SERVICES LLC

Provider Business Mailing Address
First Line	:	300 HIGHLAND VIEW DR
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-6080
Country	:	US
Telephone Number	:	337-247-7282
Fax Number	:	337-279-0776

Provider Business Practice Location Address
First Line	:	113 FLAGG PL BLDG B
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-7025
Country	:	US
Telephone Number	:	337-247-7282
Fax Number	:	337-279-0776

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT ALLEN GREEN
Credential	:	PMHNP
Telephone Number	:	337-247-7282

Provider Enumeration Date	:	12/07/2021
Last Update Date	:	01/05/2023

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