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NPI Code Detail

MEDICARE: DESTINY GREEN MSW US

MEDICARE: DESTINY GREEN MSW US
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
1104100000XSocial Worker20588OK
21041C0700XClinical Social Worker20588OK

General Provider Information

NPI Number : 1467052951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY GREEN MSW US
Provider Business Mailing Address
First Line : 1055 S HOUSTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74127-9043
Country : US
Telephone Number : 918-921-3200
Fax Number : 918-560-1399
Provider Business Practice Location Address
First Line : 1055 S HOUSTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74127-9043
Country : US
Telephone Number : 918-921-3200
Fax Number : 918-560-1399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2020
Last Update Date : 12/02/2025

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