Provider Demographics
NPI:1922206457
Name:GREEN, BETTY ANN (LPC)
Entity Type:Individual
Prefix:MISS
First Name:BETTY
Middle Name:ANN
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 1:2730 VALLEY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1985
Mailing Address - Country:US
Mailing Address - Phone:314-951-4042
Mailing Address - Fax:314-830-1601
Practice Address - Street 1:4649 WHISPER LAKE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-4306
Practice Address - Country:US
Practice Address - Phone:314-951-4042
Practice Address - Fax:314-741-4240
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20005009296101YP2500X
MO101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool