| Doctor Name: | WILLIAM MACK GREEN |
| NPI Number: | 1013246131 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW, LSAC |
| License Number: | 4932942-6006 |
| Business Practice Address: | 107 N Main St Bountiful, UT - 840106162 |
| Business Phone Number: | 8012445166 |
| Business Fax Number: | |
| Mailing Address: | 590 E Center St, CENTERVILLE |
| State: | UT |
| Postal Code: | 840142305 |
| Phone Number: | 8012445166 |
| Fax Number: | 8012952618 |
| NPI Enumeration Date: | 12/19/2009 |
| NPI Last Update Date: | 12/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 4932942-6006 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |