Individual
JENNIFER RUTH GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
140 SOUTH HOLLY STREET, MEDFORD, OR 97501
(541) 774-8200
(541) 774-7964
Mailing address
140 SOUTH HOLLY STREET, MEDFORD, OR 97501
(541) 774-8200
(541) 774-7964
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/18/2014
Last updated
12/29/2014
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