MEDICARE: BRIANNA GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205768447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA GREEN

Provider Business Mailing Address
First Line	:	1380 S OHIO AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-3077
Country	:	US
Telephone Number	:	304-610-6025
Fax Number	:

Provider Business Practice Location Address
First Line	:	4664 LARWELL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3621
Country	:	US
Telephone Number	:	614-487-7805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ BRIANNA GREEN ” Practice Location

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