Provider Demographics
NPI:1194472084
Name:GREEN COUNTRY COUNSELING PLLC
Entity Type:Organization
Organization Name:GREEN COUNTRY COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:918-760-3164
Mailing Address - Street 1:3700 W HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2107
Mailing Address - Country:US
Mailing Address - Phone:918-760-3164
Mailing Address - Fax:
Practice Address - Street 1:3104 S ELM PL STE G
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7949
Practice Address - Country:US
Practice Address - Phone:918-760-3164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health