Provider Demographics
NPI:1427693944
Name:GREEN SPOT WELLBEING LLC
Entity type:Organization
Organization Name:GREEN SPOT WELLBEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCH MH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CATLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:662-207-8595
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:MS
Mailing Address - Zip Code:38753-0304
Mailing Address - Country:US
Mailing Address - Phone:662-207-8595
Mailing Address - Fax:
Practice Address - Street 1:100 FRONT AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2461
Practice Address - Country:US
Practice Address - Phone:662-207-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)