Provider Demographics
NPI:1558316463
Name:GREEN HOUSE AND ASSOCIATES INC
Entity Type:Organization
Organization Name:GREEN HOUSE AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-253-7387
Mailing Address - Street 1:PO BOX 361327
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-1327
Mailing Address - Country:US
Mailing Address - Phone:317-253-7387
Mailing Address - Fax:317-253-7388
Practice Address - Street 1:6246 W BROADWAY # 200
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055
Practice Address - Country:US
Practice Address - Phone:317-253-7387
Practice Address - Fax:317-253-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDA9104OtherRAILROAD MEDICARE
IN000000291010OtherBCBS
IN200427380 AMedicaid
IN200427380 AMedicaid