| Doctor Name: | MR. LYLE GREEN |
| NPI Number: | 1255693990 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MHC & MFT |
| License Number: | IMH9122 |
| Business Practice Address: | 14401 Old Cutler Rd Palmetto Bay, FL - 331581722 |
| Business Phone Number: | 7865737010 |
| Business Fax Number: | |
| Mailing Address: | 14401 Old Cutler Rd, PALMETTO BAY |
| State: | FL |
| Postal Code: | 331581722 |
| Phone Number: | 7865737010 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2012 |
| NPI Last Update Date: | 06/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMH9122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |