Organization
GREEN COUNTRY MENTAL HEALTH & THERAPEUTIC SERVICES, PLC
Active
Other names
Green Country Therapeutics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY ALLAN WILSON MS, LPC-S, RPT (MANAGING DIRECTOR)
(539) 323-0125
Entity
Organization
Contact information
Practice address
4325 E 51ST ST STE 102, TULSA, OK 74135-3646
(539) 302-9192
Mailing address
5914 S 130TH WEST AVE, SAND SPRINGS, OK 74063-2391
(539) 323-0125
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200420780A
—
OK
Enumeration date
07/02/2021
Last updated
01/02/2025
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