Provider Demographics
NPI:1407155799
Name:GREEN, SHARI LYNN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:LYNN
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 1:4930 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7972
Mailing Address - Country:US
Mailing Address - Phone:407-922-1177
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST
Practice Address - Street 2:SUITE 515
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4643
Practice Address - Country:US
Practice Address - Phone:321-250-1054
Practice Address - Fax:321-256-0307
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health