MEDICARE: LATANYA 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1437720422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATANYA GREEN

Provider Business Mailing Address
First Line	:	5600 MONROE ST STE B207
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-2728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 MONROE ST STE B207
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-2728
Country	:	US
Telephone Number	:	567-408-2500
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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Directions to “ LATANYA GREEN ” Practice Location

Language	Start Address	Practice Location

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