Healthcare Provider Details

I. General information

NPI: 1225084304
Provider Name (Legal Business Name): PAULA DANETTE GREEN MS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 MESA VERDE ST STE A
SANTA FE NM
87501-1729
US

IV. Provider business mailing address

127 MESA VERDE ST STE A
SANTA FE NM
87501-1729
US

V. Phone/Fax

Practice location:
  • Phone: 208-283-6365
  • Fax:
Mailing address:
  • Phone: 208-283-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-4139
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0021417
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: