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General NPI Number Information
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NPI Number | 1801358890
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Entity Type | Individual
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Provider Name | CHRISTOPHER WINSLOW GREEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 2205 N IRONWOOD PL
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2610
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Country | US
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Telephone | 208-783-1267
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1387
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City | HAYDEN
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State | ID
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Zip | 83835-1387
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Country | US
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Telephone | 208-415-0299
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Fax | 208-625-2070
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 41618
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 38470
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License Number State | ID
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