Provider Demographics
NPI:1245780360
Name:GREYHAWK COUNSELING SERVICES, LLC.
Entity Type:Organization
Organization Name:GREYHAWK COUNSELING SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:251-200-1567
Mailing Address - Street 1:6061 COLONIAL PKWY
Mailing Address - Street 2:UNIT 6208
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-2575
Mailing Address - Country:US
Mailing Address - Phone:251-200-1567
Mailing Address - Fax:
Practice Address - Street 1:8141 STATE HIGHWAY 59
Practice Address - Street 2:SUITE 3
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3869
Practice Address - Country:US
Practice Address - Phone:251-200-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty