Organization
COUNSELING AT THE GREEN HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE RANDOLPH LMHC (FOUNDER & DIRECTOR)
(317) 455-5642
Entity
Organization
Contact information
Practice address
447 E 38TH ST, INDIANAPOLIS, IN 46205-2622
(317) 455-5642
Mailing address
447 E 38TH ST, INDIANAPOLIS, IN 46205-2622
(317) 455-5642
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
12/18/2020
Last updated
12/18/2020
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