Provider Demographics
NPI:1881457364
Name:GREEN COUNTRY BEHAVIORAL HEALTH SERVICES, INC
Entity type:Organization
Organization Name:GREEN COUNTRY BEHAVIORAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVALUATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUINTON
Authorized Official - Middle Name:OZELL
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:III
Authorized Official - Credentials:MBA, BHCMI, PRSS
Authorized Official - Phone:918-682-8407
Mailing Address - Street 1:6365 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4595
Mailing Address - Country:US
Mailing Address - Phone:918-682-8407
Mailing Address - Fax:
Practice Address - Street 1:6365 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4595
Practice Address - Country:US
Practice Address - Phone:918-682-8407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN COUNTRY BEHAVIORAL HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-06
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health