Provider Demographics
NPI:1225084304
Name:GREEN, PAULA DANETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:DANETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5802
Mailing Address - Country:US
Mailing Address - Phone:208-283-6365
Mailing Address - Fax:
Practice Address - Street 1:720 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5535
Practice Address - Country:US
Practice Address - Phone:208-343-3688
Practice Address - Fax:208-342-3366
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IDLCPC-4139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health