1871640078 NPI number — GREEN COUNTRY BEHAVIORAL HEALTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871640078 NPI number — GREEN COUNTRY BEHAVIORAL HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN COUNTRY BEHAVIORAL HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871640078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKOGEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74401-4431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-682-8407
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 E SKELLY DR STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74105-6344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-665-0208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
IT DIRECTOR
Authorized Official Telephone Number:
918-682-8407

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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