Provider Demographics
NPI:1336029313
Name:THE GREEN FERN, LLC
Entity type:Organization
Organization Name:THE GREEN FERN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/MANAGER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGERE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW 7926-C
Authorized Official - Phone:501-794-9496
Mailing Address - Street 1:PO BOX 1853
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1853
Mailing Address - Country:US
Mailing Address - Phone:501-794-9496
Mailing Address - Fax:
Practice Address - Street 1:900 S SHACKLEFORD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3817
Practice Address - Country:US
Practice Address - Phone:501-794-9496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty