| Doctor Name: | JESSIE GREEN |
| NPI Number: | 1225214398 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | 1213 Maria Ln Iuka, MS - 388521135 |
| Business Phone Number: | 6624233332 |
| Business Fax Number: | 6622868095 |
| Mailing Address: | Po Box 839, CORINTH |
| State: | MS |
| Postal Code: | 388350839 |
| Phone Number: | 6622862152 |
| Fax Number: | 6622868095 |
| NPI Enumeration Date: | 01/18/2008 |
| NPI Last Update Date: | 01/18/2008 |
| 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: | |