| Doctor Name: | SHANNON PATRICIA GREEN |
| NPI Number: | 1023252368 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | MH 8211 |
| Business Practice Address: | 490 Centre Lake Dr Ne Suite 150 Palm Bay, FL - 329071113 |
| Business Phone Number: | 3217686420 |
| Business Fax Number: | 3217686324 |
| Mailing Address: | 490 Centre Lake Dr Ne, Suite 150 PALM BAY |
| State: | FL |
| Postal Code: | 329071113 |
| Phone Number: | 3217686420 |
| Fax Number: | 3217686324 |
| NPI Enumeration Date: | 04/30/2009 |
| NPI Last Update Date: | 04/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH 8211 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |