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General NPI Number Information
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NPI Number | 1518373513
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Entity Type | Organization
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Legal Business Name | DANA BOLDT GREEN, M.ED., LPC, NCGC-2, PC
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 8800 BIRCH ST
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City | KINGSTON
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State | OK
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Zip | 73439
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Country | US
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Telephone | 580-565-2252
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1800
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City | KINGSTON
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State | OK
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Zip | 73439-1800
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Country | US
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Telephone | 580-565-2252
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANA GREEN
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Credential | LPC
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Telephone | 58505652252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2011
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License Number State | OK
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