Individual
LAUREN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 453-1400
(414) 453-2538
Mailing address
9000 W WISCONSIN AVE # MS 958, MILWAUKEE, WI 53226-4874
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8379-125
WI
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316535008
—
WI
Enumeration date
01/07/2021
Last updated
01/03/2022
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