Provider Demographics
NPI:1013377647
Name:GREENHOUSE THERAPY
Entity Type:Organization
Organization Name:GREENHOUSE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:916-716-1795
Mailing Address - Street 1:2358 MARITIME DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3662
Mailing Address - Country:US
Mailing Address - Phone:916-716-1795
Mailing Address - Fax:916-685-6826
Practice Address - Street 1:2358 MARITIME DR STE 110
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3662
Practice Address - Country:US
Practice Address - Phone:916-716-1795
Practice Address - Fax:916-685-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53491103K00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty