Provider Demographics
NPI:1376178152
Name:GREEN, HALLIE (LMHC)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 W STATE ST STE 309
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1866
Mailing Address - Country:US
Mailing Address - Phone:716-790-8202
Mailing Address - Fax:
Practice Address - Street 1:2646 W STATE ST STE 309
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1866
Practice Address - Country:US
Practice Address - Phone:716-790-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional