Healthcare Provider Details

I. General information

NPI: 1760858047
Provider Name (Legal Business Name): MELANIE GREEN LMSW, LCSW, PSSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W 8TH ST
MIO MI
48647-9143
US

IV. Provider business mailing address

1110 W 8TH ST
MIO MI
48647-9143
US

V. Phone/Fax

Practice location:
  • Phone: 989-826-2400
  • Fax:
Mailing address:
  • Phone: 989-826-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801089617
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: