Individual
MRS. HEATHER DIANA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED, LPC
Contact information
Practice address
1085 MAPLE ST, FARMINGTON, MO 63640-1955
(314) 243-3793
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2012014744
MO
101YM0800X
Mental Health Counselor
2012014744
MO
101YP2500X
Professional Counselor
Primary
2012014744
MO
Other
Enumeration date
11/03/2014
Last updated
11/22/2022
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