Individual
JENNIFER ELAINE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12562 BENNINGTON PL, SAINT LOUIS, MO 63146-2772
Mailing address
12562 BENNINGTON PL, SAINT LOUIS, MO 63146-2772
(314) 488-9101
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2019008151
MO
Other
Enumeration date
11/30/2021
Last updated
11/30/2021
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