Doctor Name: | MR. TROY GREEN |
NPI Number: | 1467771840 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | CP00004152 |
Business Practice Address: | 315 W Marcy Ave Montesano, WA - 985633618 |
Business Phone Number: | 3604822674 |
Business Fax Number: | |
Mailing Address: | Po Box 1034, ELMA |
State: | WA |
Postal Code: | 985411034 |
Phone Number: | 3604822674 |
Fax Number: | |
NPI Enumeration Date: | 05/24/2010 |
NPI Last Update Date: | 05/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CP00004152 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |