Provider Demographics
NPI:1922539154
Name:GREEN, CURTIS O'NEAL (BS)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:O'NEAL
Last Name:GREEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 RAIN STORM CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-4857
Mailing Address - Country:US
Mailing Address - Phone:702-987-5508
Mailing Address - Fax:
Practice Address - Street 1:2007 RAIN STORM CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4857
Practice Address - Country:US
Practice Address - Phone:702-987-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional