Healthcare Provider Details

I. General information

NPI: 1689182511
Provider Name (Legal Business Name): ERIC MELVIN GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 TURNBERRY DR
NORMAN OK
73069-9510
US

IV. Provider business mailing address

321 TURNBERRY DR
NORMAN OK
73069-9510
US

V. Phone/Fax

Practice location:
  • Phone: 301-704-1270
  • Fax: 405-310-2367
Mailing address:
  • Phone: 301-704-1270
  • Fax: 301-704-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: