Individual
MS. TERI GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5701 W TALAVI BLVD, SUITE 180, GLENDALE, AZ 85306-1886
(623) 486-8202
(623) 486-2739
Mailing address
4220 N 20TH AVE, PHOENIX, AZ 85015-5101
(602) 279-7655
(602) 241-5756
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-12722
AZ
101YM0800X
Mental Health Counselor
LMSW-11867
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW-12722
STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS
AZ
01
—
LMSW-11867
BOARD OF BEHAVIORAL HEALTH EXAMINERS
AZ
Enumeration date
06/25/2007
Last updated
09/15/2011
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