Doctor Name: | MR. DOUGLAS GREENE |
NPI Number: | 1093970725 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | QMHA |
License Number: | |
Business Practice Address: | 1840 Union Ave North Bend, OR - 974593422 |
Business Phone Number: | 5417562057 |
Business Fax Number: | 5417517905 |
Mailing Address: | 1840 Union Ave, NORTH BEND |
State: | OR |
Postal Code: | 974593422 |
Phone Number: | 5417562057 |
Fax Number: | 5417517905 |
NPI Enumeration Date: | 07/22/2008 |
NPI Last Update Date: | 07/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |