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NPI Code Detail

MEDICARE: DR. DEBORAH K GREEN D.MIN, LPC

MEDICARE: DR. DEBORAH K GREEN D.MIN, LPC
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 Counselor1499OK

General Provider Information

NPI Number : 1659486694
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBORAH K GREEN D.MIN, LPC
Provider Business Mailing Address
First Line : 407 N EISENHOWER ST
Second Line :
City : ENID
State : OK
Zip : 73703-3814
Country : US
Telephone Number : 580-242-5544
Fax Number : 580-233-8905
Provider Business Practice Location Address
First Line : 230 W MAPLE AVE
Second Line :
City : ENID
State : OK
Zip : 73701-4012
Country : US
Telephone Number : 580-242-5544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 07/08/2007

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