Provider Demographics
NPI:1134711328
Name:GREEN, KIP L (LPC)
Entity type:Individual
Prefix:MR
First Name:KIP
Middle Name:L
Last Name:GREEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:AL
Mailing Address - Zip Code:35116-1420
Mailing Address - Country:US
Mailing Address - Phone:205-572-1090
Mailing Address - Fax:
Practice Address - Street 1:8310 2ND AVE S
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:AL
Practice Address - Zip Code:35116-1420
Practice Address - Country:US
Practice Address - Phone:205-572-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional