Provider Demographics
NPI:1043741465
Name:GREENTREE COUNSELING CENTER
Entity Type:Organization
Organization Name:GREENTREE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:330-372-2200
Mailing Address - Street 1:430 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5715
Mailing Address - Country:US
Mailing Address - Phone:330-372-2200
Mailing Address - Fax:
Practice Address - Street 1:430 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5715
Practice Address - Country:US
Practice Address - Phone:330-372-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-0560Medicaid