Provider Demographics
NPI:1770043085
Name:GREEN COUCH COUNSELING, INC.
Entity Type:Organization
Organization Name:GREEN COUCH COUNSELING, INC.
Other - Org Name:GREEN COUCH COUNSELING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-520-8096
Mailing Address - Street 1:1100 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2611
Mailing Address - Country:US
Mailing Address - Phone:720-779-0351
Mailing Address - Fax:303-371-5148
Practice Address - Street 1:2311 S PLATTE RIVER DR STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-4201
Practice Address - Country:US
Practice Address - Phone:720-779-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356740922OtherNPI 1