Provider Information for 1922206457
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Miss BETTY ANN GREEN LPC
Sex: Female
NPI: 1922206457
Last Updated: 2015-08-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1922206457 | ||||||||||||
| Enumeration Date | 2007-07-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2730 VALLEY BROOK DR FLORISSANT, MO 63031-1985 United States Phone: 314-951-4042 | Fax:314-830-1601 | ||||||||||||
| Primary Practice Address | 4649 WHISPER LAKE DR FLORISSANT, MO 63033-4306 United States Phone: 314-951-4042 | Fax:314-741-4240 | ||||||||||||
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