DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: IVAN JEROME GREEN

MEDICARE: IVAN JEROME 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
1101Y00000XCounselor

General Provider Information

NPI Number : 1548046568
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN JEROME GREEN
Provider Business Mailing Address
First Line : 3762 TUNDRA SWAN ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-3536
Country : US
Telephone Number : 323-212-0072
Fax Number :
Provider Business Practice Location Address
First Line : 3762 TUNDRA SWAN ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-3536
Country : US
Telephone Number : 323-212-0072
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2023
Last Update Date : 09/05/2023

Similar Medicare Providers

1093411795 — SECOND CHANCE EMPOWERMENT CENTER
Practice Location Address:
3810 TUNDRA SWAN ST
LAS VEGAS, NV
89122-3536
Practice Phone: 702-741-3784
Practice Fax:
1710001037 — MELISSA MARIE MCCAFFERTY MFT
Practice Location Address:
5105 SMOKE RANCH RD
LAS VEGAS, NV
89108-3536
Practice Phone: 702-638-0395
Practice Fax: 702-638-0362
1083735914 — BENCHMARK BEHAVIORAL HEALTH SYSTEM INC
Practice Location Address:
5105 SMOKE RANCH RD
LAS VEGAS, NV
89108-3536
Practice Phone: 702-638-0395
Practice Fax: 702-638-0362
1023219383 — BENCHMARK BEHAVIORAL HEALTH SYSTEMS
Practice Location Address:
5105 SMOKE RANCH RD
LAS VEGAS, NV
89108-3536
Practice Phone: 702-638-0395
Practice Fax: 702-638-0362
1043520471 — ELLIOT MARSH
Practice Location Address:
5105 SMOKE RANCH RD
LAS VEGAS, NV
89108-3536
Practice Phone: 702-638-0395
Practice Fax: 702-638-0362
1720398159 — ANTHONY JACOB BACA JR.
Practice Location Address:
5105 SMOKE RANCH RD
LAS VEGAS, NV
89108-3536
Practice Phone: 702-638-0395
Practice Fax: 702-638-0362

Directions to “ IVAN JEROME GREEN ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.