Healthcare Provider Details

I. General information

NPI: 1821471921
Provider Name (Legal Business Name): ZELLA Y. GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES RD STE 1230
SHREVEPORT LA
71129-3900
US

IV. Provider business mailing address

7505 PINES RD STE 1230
SHREVEPORT LA
71129-3900
US

V. Phone/Fax

Practice location:
  • Phone: 318-562-3707
  • Fax:
Mailing address:
  • Phone: 318-562-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11889
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: