Provider Demographics
NPI:1447649124
Name:GREEN, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 YARMOUTH AVE
Mailing Address - Street 2:UNIT C-1B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4803
Mailing Address - Country:US
Mailing Address - Phone:303-786-9314
Mailing Address - Fax:
Practice Address - Street 1:1200 YARMOUTH AVE
Practice Address - Street 2:UNIT C-1B
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4803
Practice Address - Country:US
Practice Address - Phone:303-786-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0104273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health