Individual
MRS. MALITA ELICE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
102 ASHLEY DR, SHAWNEE, OK 74804-9710
(405) 808-5875
Mailing address
102 ASHLEY DR, SHAWNEE, OK 74804-9710
(405) 808-5875
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/10/2012
Last updated
04/10/2012
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