Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 1000000021968 | TN |
NPI | 1639660103 |
---|---|
Provider Name | Ms. Jennifer Green |
First Address | Memphis, TN 38127 |
Second Address | Memphis, TN 38127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2018 |
Last Update Date | 21/05/2018 |