Healthcare Provider Details

I. General information

NPI: 1124466719
Provider Name (Legal Business Name): MORGAN GREEN M.A., CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 S MCCARRAN BLVD
RENO NV
89502-9513
US

IV. Provider business mailing address

PO BOX 52230
SPARKS NV
89435-2230
US

V. Phone/Fax

Practice location:
  • Phone: 775-954-1400
  • Fax: 775-954-1406
Mailing address:
  • Phone: 775-954-1400
  • Fax: 775-954-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01039
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: