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General NPI Number Information
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NPI Number | 1346379211
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Entity Type | Individual
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Provider Name | CHRISTOPHER MILES GREEN MA, LLP
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 822 WYANDOTTE AVE.
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City | ROYAL OAK
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State | MI
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Zip | 48067
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Country | US
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Telephone | 248-795-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 822 WYANDOTTE AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3368
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Country | US
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Telephone | 248-795-1747
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6361003236
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License Number State | MI
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