UPI (Provider ID): 12402
Change Report (if Any):

Short Name: GREENTREE CNTR

Long Name 1: GREENTREE COUNSELING CENTER
Long Name 2: INC

Address 1: 3915 EAST MARKET STREET
Address 2: SUITE 404

City: WARREN
Zip Code: 44484
County: TRUM

Contact: MELISSA TRUMBLE
Title: LPLL
Phone: 3303722200
FAX: 3303722600

Vendor: 12402

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/08/2011

File Produced: 19MAY2012