Provider Demographics
NPI:1801949839
Name:GREEN, EVELYN LORAINE (LPC, CST)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:LORAINE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 E 17TH AVE
Mailing Address - Street 2:#3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1813
Mailing Address - Country:US
Mailing Address - Phone:303-333-4074
Mailing Address - Fax:
Practice Address - Street 1:3500 E 17TH AVE
Practice Address - Street 2:#3
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1813
Practice Address - Country:US
Practice Address - Phone:303-333-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 3023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health