Provider Demographics
NPI:1679921258
Name:GREEN, MIKE
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 AIRLINE DR
Mailing Address - Street 2:SUITE 211D
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7809 AIRLINE DR
Practice Address - Street 2:SUITE 211D
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6439
Practice Address - Country:US
Practice Address - Phone:504-731-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor