Provider Demographics
NPI:1295591840
Name:GREEN, DONALD R (QMHA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:GREEN
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:R
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PWS, PSW, QMHA
Mailing Address - Street 1:38134 PLACE RD
Mailing Address - Street 2:
Mailing Address - City:FALL CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97438-9722
Mailing Address - Country:US
Mailing Address - Phone:541-222-0613
Mailing Address - Fax:
Practice Address - Street 1:37875 JASPER LOWELL RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:OR
Practice Address - Zip Code:97438-9751
Practice Address - Country:US
Practice Address - Phone:541-747-1235
Practice Address - Fax:541-747-4722
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health