Provider Demographics
NPI:1023584596
Name:GREEN, TALIA
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E SWANSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7025
Mailing Address - Country:US
Mailing Address - Phone:907-864-0560
Mailing Address - Fax:907-864-0564
Practice Address - Street 1:133 E SWANSON AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7025
Practice Address - Country:US
Practice Address - Phone:907-864-0560
Practice Address - Fax:907-864-0564
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor