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Individual

DR. KEVIN M GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD, MS

Contact information

Practice address
199 N 290 W, SUITE 150, LINDON, UT 84042-1810
(801) 406-8994
Mailing address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 359-4840

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
50020653902
UT
106H00000X
Marriage & Family Therapist
LMFT-6350
ID
106H00000X
Marriage & Family Therapist

Other

Enumeration date
09/05/2013
Last updated
11/12/2024
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