Individual
TIMOTHY BRUCE GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8836 S VERMONT AVE, LOS ANGELES, CA 90044-4832
(323) 751-3026
Mailing address
425 S BROADWAY, LOS ANGELES, CA 90013-1102
(213) 213-0100
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
WA
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/14/2021
Last updated
05/13/2022
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