Provider Demographics
NPI:1053732016
Name:ANNE M. GREEN, INC.
Entity type:Organization
Organization Name:ANNE M. GREEN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-358-9397
Mailing Address - Street 1:2000 JAMES ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1882
Mailing Address - Country:US
Mailing Address - Phone:319-358-9397
Mailing Address - Fax:
Practice Address - Street 1:2000 JAMES ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1882
Practice Address - Country:US
Practice Address - Phone:319-358-9397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00627103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty