Provider Demographics
NPI:1396960878
Name:GREEN, SHELLEY A (MS/LPC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS/LPC
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:A
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2603 RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-7639
Mailing Address - Country:US
Mailing Address - Phone:918-687-3532
Mailing Address - Fax:
Practice Address - Street 1:2603 RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-7639
Practice Address - Country:US
Practice Address - Phone:918-687-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OK5877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)