Provider Demographics
NPI:1851779540
Name:GREEN, E'ULA (LMSW)
Entity Type:Individual
Prefix:
First Name:E'ULA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PENN AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3847
Mailing Address - Country:US
Mailing Address - Phone:918-337-8080
Mailing Address - Fax:918-337-8099
Practice Address - Street 1:700 S PENN AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3847
Practice Address - Country:US
Practice Address - Phone:808-091-8337
Practice Address - Fax:918-337-8099
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7387104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health