Individual
REBECCA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2424 32ND AVE S, STE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Mailing address
2424 32ND AVE S, STE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
270
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1451969
—
ND
05
—
18288
—
ND
01
—
24743
BLUECROSSBLUESHIELD OF ND
ND
01
—
309K9GR
BLUECROSSBLUESHIELD OF MN
MN
01
—
498806
VALUE OPTIONS
ND
01
—
61-66614
UBH
ND
Enumeration date
10/03/2006
Last updated
01/23/2017
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