MEDICARE: JASON DWIN GREEN ED.D,HON. D.COUNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	18090	TX
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1124904529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON DWIN GREEN ED.D,HON. D.COUNS

Provider Business Mailing Address
First Line	:	5616 GRANDMOTHER HAT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6467
Country	:	US
Telephone Number	:	310-597-0282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5616 GRANDMOTHER HAT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6467
Country	:	US
Telephone Number	:	310-597-0282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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