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General NPI Number Information
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NPI Number | 1275301251
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Entity Type | Individual
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Provider Name | BENJAMIN JACOB GREENE LPCC
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Gender | Male
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 777 S WADSWORTH BLVD # 2-103A
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City | LAKEWOOD
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State | CO
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Zip | 80226-4300
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Country | US
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Telephone | 720-485-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 6750 E CHENANGO AVE APT 374
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City | DENVER
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State | CO
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Zip | 80237-3160
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Country | US
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Telephone | 720-778-1779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0021582
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License Number State | CO
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