Provider Demographics
NPI:1447683693
Name:GREEN, DENISE E
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEE
Other - Middle Name:E
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1326 CRIMSON LEAF DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6285
Mailing Address - Country:US
Mailing Address - Phone:574-361-2393
Mailing Address - Fax:
Practice Address - Street 1:56218 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9326
Practice Address - Country:US
Practice Address - Phone:574-293-0005
Practice Address - Fax:574-293-0019
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health