Provider Demographics
NPI:1326003260
Name:GREENE COUNTY EDUCATIONAL SERVICE CENTER
Entity Type:Organization
Organization Name:GREENE COUNTY EDUCATIONAL SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF MENTAL HEALTH PROGRA
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOCHSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:937-767-1303
Mailing Address - Street 1:360 EAST ENON RD
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1499
Mailing Address - Country:US
Mailing Address - Phone:937-767-1303
Mailing Address - Fax:937-767-1025
Practice Address - Street 1:360 EAST ENON RD
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1499
Practice Address - Country:US
Practice Address - Phone:937-767-1303
Practice Address - Fax:937-767-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC0825Medicaid
10197Medicare UPIN