Provider Demographics
NPI:1679704985
Name:GREEN, LORI (MHRS)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 SANTO ANTONIO DR
Mailing Address - Street 2:#18
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-7107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10001 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3507
Practice Address - Country:US
Practice Address - Phone:951-343-2536
Practice Address - Fax:951-729-3309
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health