Healthcare Provider Details

I. General information

NPI: 1710811880
Provider Name (Legal Business Name): STEVEN MANUEL GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 POLAR BEAR CIR
GALT CA
95632-3074
US

IV. Provider business mailing address

750 SPAANS DR
GALT CA
95632-8609
US

V. Phone/Fax

Practice location:
  • Phone: 209-744-6075
  • Fax:
Mailing address:
  • Phone: 209-744-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDRC25908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: