Provider Demographics
NPI:1134014814
Name:GREEN, LATRESE (CHES, CCHW, RYT,)
Entity type:Individual
Prefix:
First Name:LATRESE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CHES, CCHW, RYT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7059 DAWSON RD LOT 94
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2573
Mailing Address - Country:US
Mailing Address - Phone:283-333-6616
Mailing Address - Fax:
Practice Address - Street 1:7059 DAWSON RD LOT 94
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2573
Practice Address - Country:US
Practice Address - Phone:283-333-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
40598174H00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach