Healthcare Provider Details

I. General information

NPI: 1144794363
Provider Name (Legal Business Name): NIKKI GREEN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7927 FLOYD ST
OVERLAND PARK KS
66204-3724
US

IV. Provider business mailing address

7927 FLOYD ST
OVERLAND PARK KS
66204-3724
US

V. Phone/Fax

Practice location:
  • Phone: 913-302-8450
  • Fax:
Mailing address:
  • Phone: 913-302-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLETTE GREEN
Title or Position: OWNER
Credential: LSCSW, LCAC
Phone: 913-302-8450