Organization
DANA BOLDT GREEN, M.ED., LPC, NCGC-2, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA GREEN LPC (PRESIDENT)
58505652252
Entity
Organization
Contact information
Practice address
8800 BIRCH ST, KINGSTON, OK 73439
(580) 565-2252
Mailing address
PO BOX 1800, KINGSTON, OK 73439-1800
(580) 565-2252
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2011
OK
Other
Enumeration date
07/10/2014
Last updated
07/10/2014
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