| Green Country Therapeutics | |
|
4325 E 51st St Ste 102 Tulsa OK 74135-3646 | |
| (539) 302-9192 | |
| Not Available |
| Full Name | Green Country Therapeutics |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4325 E 51st St Ste 102, Tulsa, Oklahoma |
| Authorized Official Name and Position | Jeffery Allan Wilson (MANAGING DIRECTOR) |
| Authorized Official Contact | 5393230125 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Country Therapeutics 5914 S 130th West Ave Sand Springs OK 74063-2391 Ph: (539) 323-0125 | Green Country Therapeutics 4325 E 51st St Ste 102 Tulsa OK 74135-3646 Ph: (539) 302-9192 |
| NPI Number | 1447821293 |
|---|---|
| Provider Enumeration Date | 07/02/2021 |
| Last Update Date | 03/08/2024 |
| Certification Date | 03/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447821293 | NPI | - | NPPES |
| 200420780A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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