Provider Demographics
NPI:1124904529
Name:GREEN, JASON DWIN (EDD,HON DCOUNS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DWIN
Last Name:GREEN
Suffix:
Gender:M
Credentials:EDD,HON DCOUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 GRANDMOTHER HAT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6467
Mailing Address - Country:US
Mailing Address - Phone:310-597-0282
Mailing Address - Fax:
Practice Address - Street 1:5616 GRANDMOTHER HAT ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6467
Practice Address - Country:US
Practice Address - Phone:310-597-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18090101YP1600X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171400000XOther Service ProvidersHealth & Wellness Coach