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General NPI Number Information
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NPI Number | 1689537698
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Entity Type | Individual
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Provider Name | MIA GREEN
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 6436 S US HIGHWAY 85-87
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City | FOUNTAIN
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State | CO
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Zip | 80817-1005
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Country | US
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Telephone | 719-822-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 7125 YAMPA RIVER HTS
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City | FOUNTAIN
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State | CO
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Zip | 80817-1570
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Country | US
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Telephone | 719-930-5253
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | CO
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