Provider Demographics
NPI:1265818090
Name:GREEN, EMILY KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KAY
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N BENT ST STE B
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2742
Mailing Address - Country:US
Mailing Address - Phone:307-764-4107
Mailing Address - Fax:307-764-1879
Practice Address - Street 1:130 N BENT ST STE B
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2742
Practice Address - Country:US
Practice Address - Phone:307-764-4107
Practice Address - Fax:307-764-1879
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-10631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical