Provider Demographics
NPI:1871339267
Name:GREEN RIVER COUNSELING LLC
Entity type:Organization
Organization Name:GREEN RIVER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-537-5302
Mailing Address - Street 1:100 C D LOCKE RD
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-8045
Mailing Address - Country:US
Mailing Address - Phone:270-537-5302
Mailing Address - Fax:888-892-4175
Practice Address - Street 1:100 C D LOCKE RD
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-8045
Practice Address - Country:US
Practice Address - Phone:270-537-5302
Practice Address - Fax:888-892-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty