Provider Demographics
NPI:1427571637
Name:GREEN VALLEY THERAPY
Entity Type:Organization
Organization Name:GREEN VALLEY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:PIETRZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-219-7597
Mailing Address - Street 1:1770 W HORIZON RIDGE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5024
Mailing Address - Country:US
Mailing Address - Phone:702-219-7597
Mailing Address - Fax:
Practice Address - Street 1:1770 W HORIZON RIDGE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5024
Practice Address - Country:US
Practice Address - Phone:702-219-7597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4104-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty