Provider Demographics
NPI:1396860821
Name:GREEN, JUDITH H (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:H
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ACACIA CIRCLE
Mailing Address - Street 2:#504
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-784-0014
Mailing Address - Fax:
Practice Address - Street 1:125 ACACIA CIRCLE
Practice Address - Street 2:#504
Practice Address - City:INDIAN HEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-784-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCERT# 5603101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623196OtherBLUE CROSS BLUE SHIELD