Green, Cornelia Ellis

Green, Cornelia Ellis is an sole proprietor health care provider with primary practice located at 419 Pleasant St Suite 313, Beloit WI 53511-6249. She recently has only one registered license in Behavioral Health & Social Service Providers / Counseling, which is considered as her primary health care specialty. Green, Cornelia Ellis can be contacted via phone (608) 365-7078.

Contact Information

Primary practice address
419 Pleasant St Suite 313 Beloit WI 53511-6249
Fax: (608) 365-7464
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counseling 103TC1900X 951-057 Wisconsin

Profile Details

NPI number 1023162468
LBN Legal business name Green, Cornelia Ellis
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 23rd, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023162468 NPPES
Wisconsin MEDICAID 39027300

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