Individual
MS. MARY JANE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC CANDIDATE
Contact information
Practice address
511 E 2ND ST, HEAVENER, OK 74937-3419
(918) 653-7718
(918) 653-7279
Mailing address
511 E 2ND ST, HEAVENER, OK 74937-3419
(918) 653-7718
(918) 653-7279
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100706960F
—
OK
Enumeration date
09/18/2007
Last updated
07/06/2012
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