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Organization
TIM GREEN LMHC LLC
Active
Organization
TIM GREEN LMHC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM GREEN LMHC (OWNER)
(239) 321-0797
Entity
Organization
Contact information
Practice address
9500 CORKSCREW PALMS CIR STE 3, ESTERO, FL 33928
(239) 321-0797
(239) 390-0241
Mailing address
229 AMBURY ST, FORT MYERS, FL 33913-7131
(239) 321-0797
(239) 390-0241
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH7986
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689780603
NPI
—
Enumeration date
06/15/2017
Last updated
07/21/2022
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