Individual
DR. MARK STEPHEN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., L.P.
Contact information
Practice address
9415 E HARRY ST, SUITE 703, WICHITA, KS 67207-5089
(316) 978-6102
Mailing address
1845 FAIRMOUNT ST, BOX 91, WICHITA, KS 67260-0091
(316) 978-6102
(316) 978-3216
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2354
KS
Other
Enumeration date
09/26/2015
Last updated
09/26/2015
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