Individual
MR. GARY LANE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC, LMFT
Contact information
Practice address
1232 W POPLAR ST, ROGERS, AR 72756-4246
(479) 936-5944
Mailing address
PO BOX 793, ROGERS, AR 72757-0793
(479) 936-5944
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
P1205057
AR
106H00000X
Marriage & Family Therapist
Primary
M1205005
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12387051
CAQH
—
Enumeration date
02/21/2009
Last updated
06/26/2012
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