Green, Shannon Patricia

Green, Shannon Patricia is an individual health care provider with primary practice located at 490 Centre Lake Dr Ne Suite 150, Palm Bay FL 32907-1113. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Green, Shannon Patricia can be contacted via phone (321) 768-6420.

Contact Information

Primary practice address
490 Centre Lake Dr Ne Suite 150 Palm Bay FL 32907-1113
Phone: (321) 768-6420
Fax: (321) 768-6324
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH 8211 Florida

Profile Details

NPI number 1023252368
LBN Legal business name Green, Shannon Patricia
Credentials LMHC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 30th, 2009
Last updated Apr 30th, 2009 - about 15 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 1023252368 NPPES
Florida MEDICAID 767205522

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