Doctor Name: | GORDON GUY GREEN |
NPI Number: | 1427279124 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. |
License Number: | 133 |
Business Practice Address: | 1800 N 16th St Clarinda, IA - 516321165 |
Business Phone Number: | 7125422388 |
Business Fax Number: | 7125422984 |
Mailing Address: | 1102 Sycamore St, TARKIO |
State: | MO |
Postal Code: | 644911250 |
Phone Number: | 7123037907 |
Fax Number: | |
NPI Enumeration Date: | 05/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 133 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |