MEDICARE: DR. DOL UNEN GREEN LPC

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	101YP2500X	Professional Counselor	0000011	CO
2	101YP2500X	Professional Counselor	64508	TX

General Provider Information

NPI Number	:	1831819812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOL UNEN GREEN LPC

Provider Business Mailing Address
First Line	:	7878 SILVER BIRCH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4042
Country	:	US
Telephone Number	:	805-717-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	7878 SILVER BIRCH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4042
Country	:	US
Telephone Number	:	805-717-0212
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	08/31/2022

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