Provider Demographics
NPI:1316190010
Name:GREENBUSH OAKS, INC
Entity Type:Organization
Organization Name:GREENBUSH OAKS, INC
Other - Org Name:POYNETTE COUNSELING & PSYCHOTHERAPY ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOESER
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:608-635-2146
Mailing Address - Street 1:415 N MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-8963
Mailing Address - Country:US
Mailing Address - Phone:608-635-2146
Mailing Address - Fax:608-635-7379
Practice Address - Street 1:415 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-8963
Practice Address - Country:US
Practice Address - Phone:608-635-2146
Practice Address - Fax:608-635-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1169-132101YA0400X
WI2017-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42149300Medicaid