Provider Demographics
NPI:1891115531
Name:GREEN, NICOLE CARA (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CARA
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 SW LANDAU PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1013
Mailing Address - Country:US
Mailing Address - Phone:503-409-9253
Mailing Address - Fax:
Practice Address - Street 1:9950 SW LANDAU PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-1013
Practice Address - Country:US
Practice Address - Phone:503-409-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional