Individual
RANDALL L GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD CLINICAL PSYCHOL
Contact information
Practice address
2250 D ST NE, SALEM, OR 97301-2768
(503) 364-6093
(503) 364-5121
Mailing address
2250 D ST NE, SALEM, OR 97301-2768
(503) 364-6093
(503) 364-5121
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
585
OR
Other
Enumeration date
11/30/2006
Last updated
03/06/2008
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