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NPI Code Detail

MEDICARE: MOLLY JANE GREEN MA

MEDICARE: MOLLY JANE GREEN MA
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
1101YP2500XProfessional Counselor2018029026MO
2101YP2500XProfessional Counselor180007619IL

General Provider Information

NPI Number : 1467733311
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY JANE GREEN MA
Provider Business Mailing Address
First Line : 4121 UNION RD STE 225
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-1093
Country : US
Telephone Number : 314-730-6787
Fax Number : 314-730-6585
Provider Business Practice Location Address
First Line : 4121 UNION RD STE 225
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-1093
Country : US
Telephone Number : 314-730-6787
Fax Number : 314-730-6585
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2011
Last Update Date : 04/10/2026

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Directions to “ MOLLY JANE GREEN MA” Practice Location

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