Provider Demographics
NPI:1669879904
Name:GREENLEAF PROFESSIONAL COUNSELING LLC
Entity type:Organization
Organization Name:GREENLEAF PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER, PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:479-208-6464
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-0021
Mailing Address - Country:US
Mailing Address - Phone:479-208-6464
Mailing Address - Fax:918-516-0482
Practice Address - Street 1:5004 S U ST STE 203
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3600
Practice Address - Country:US
Practice Address - Phone:479-208-6464
Practice Address - Fax:918-516-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1306053101Y00000X
OK5262101Y00000X
ARM1306006106H00000X
OK1115106H00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty