Provider Demographics
NPI:1801026935
Name:GREENTREE COUNSELING LLC
Entity Type:Organization
Organization Name:GREENTREE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LUEBKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:262-249-0830
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:ZENDA
Mailing Address - State:WI
Mailing Address - Zip Code:53195-0100
Mailing Address - Country:US
Mailing Address - Phone:262-249-0830
Mailing Address - Fax:262-249-0835
Practice Address - Street 1:160 E GENEVA SQ
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-9694
Practice Address - Country:US
Practice Address - Phone:262-249-0830
Practice Address - Fax:262-249-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3556-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39637100Medicaid
WI39637100Medicaid