| Doctor Name: | CHANNIN GREEN |
| NPI Number: | 1215394903 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 23445 Gauthier St Plaquemine, LA - 707642665 |
| Business Phone Number: | 2253859867 |
| Business Fax Number: | |
| Mailing Address: | 23445 Gauthier St, PLAQUEMINE |
| State: | LA |
| Postal Code: | 707642665 |
| Phone Number: | 2253859867 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2016 |
| NPI Last Update Date: | 01/26/2016 |
| 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: | |