Provider Demographics
NPI:1356619076
Name:GREEN, COURTNEY A
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:A
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 1:602 SW A AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3930
Mailing Address - Country:US
Mailing Address - Phone:580-355-0072
Mailing Address - Fax:580-355-0232
Practice Address - Street 1:602 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3930
Practice Address - Country:US
Practice Address - Phone:580-355-0072
Practice Address - Fax:580-355-0232
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker