Provider Demographics
NPI:1346393840
Name:GREEN, KELLEY BANKS (MS, PLMHP, CPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:BANKS
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, PLMHP, CPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 F STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117
Mailing Address - Country:US
Mailing Address - Phone:402-397-9866
Mailing Address - Fax:402-397-1404
Practice Address - Street 1:5115 F STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117
Practice Address - Country:US
Practice Address - Phone:402-397-9866
Practice Address - Fax:402-397-1404
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health