Individual
MERCIFUL GRACE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
529 WESTPORT RD, ELIZABETHTOWN, KY 42701-2923
(270) 807-0316
(502) 805-1511
Mailing address
208 S MILES ST, ELIZABETHTOWN, KY 42701-1522
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
KY
Other
Enumeration date
10/29/2024
Last updated
10/29/2024
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