Provider Demographics
NPI:1992072730
Name:GREEN, PAT (PHD, CRC)
Entity type:Individual
Prefix:DR
First Name:PAT
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 MARTIN LUTHER KING, JR. ST.
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:908-361-9831
Mailing Address - Fax:601-445-0969
Practice Address - Street 1:917 N MARTIN LUTHER KING JR ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-2826
Practice Address - Country:US
Practice Address - Phone:908-361-9831
Practice Address - Fax:601-445-0969
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00015299225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor