Individual
LARRY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1001 NE 16TH AVE, GAINESVILLE, FL 32601-2511
(352) 448-9120
Mailing address
18015 SW 95TH AVE, ARCHER, FL 32618-3407
(352) 448-9120
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT2733
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT2733
LICENSE
FL
Enumeration date
07/28/2010
Last updated
10/02/2019
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