Individual
PERCY GREEN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4516 WICHITA AVE, SAINT LOUIS, MO 63110-1525
(314) 533-1686
Mailing address
4516 WICHITA AVE, SAINT LOUIS, MO 63110-1525
(314) 533-1686
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
000143
MO
Other
Enumeration date
02/12/2007
Last updated
07/08/2007
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