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General NPI Number Information
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NPI Number | 1780904318
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Entity Type | Individual
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Provider Name | CANDICE MICHELLE GREEN M.S
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Gender | Female
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Dates
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Enumeration Date | 06/05/2010
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 1402 N FLORENCE AVE STE B
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City | CLAREMORE
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State | OK
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Zip | 74017-3159
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Country | US
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Telephone | 918-619-3833
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 N FLORENCE AVE STE B
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City | CLAREMORE
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State | OK
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Zip | 74017-3159
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Country | US
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Telephone | 918-608-0380
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Fax | 209-425-5727
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0017454
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5437
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 100100
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.2505556
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.2505556
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License Number State | NJ
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