| Doctor Name: | DR. CORNELIA ELLIS GREEN |
| NPI Number: | 1023162468 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 951-057 |
| Business Practice Address: | 419 Pleasant St Suite 313 Beloit, WI - 535116249 |
| Business Phone Number: | 6083657078 |
| Business Fax Number: | 6083657464 |
| Mailing Address: | 419 Pleasant St, Suite 313 BELOIT |
| State: | WI |
| Postal Code: | 535116249 |
| Phone Number: | 6083657078 |
| Fax Number: | 6083657464 |
| NPI Enumeration Date: | 01/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 951-057 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |