Provider Demographics
NPI:1912433475
Name:GREEN CONSULTING AND STAFFINC, LLC
Entity Type:Organization
Organization Name:GREEN CONSULTING AND STAFFINC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MEKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-382-9583
Mailing Address - Street 1:2942 N 24TH ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7844
Mailing Address - Country:US
Mailing Address - Phone:480-382-9583
Mailing Address - Fax:
Practice Address - Street 1:2942 N 24TH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7844
Practice Address - Country:US
Practice Address - Phone:480-382-9583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-16083101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty