Individual
MISTI MARIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, LMFT, CRC
Contact information
Practice address
379 6TH AVE W, BRADENTON, FL 34205-8820
(941) 782-4100
(941) 782-4101
Mailing address
PO BOX 9478, BRADENTON, FL 34206-9478
(941) 782-4299
(941) 782-4301
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH12629
FL
106H00000X
Marriage & Family Therapist
Primary
MT2905
FL
Other
Enumeration date
07/09/2012
Last updated
06/13/2014
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