Individual
MR. JAMES THEODORE GREEN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
7400 S RACINE AVE, SUITE 101, CHICAGO, IL 60636-4114
(773) 874-9715
(773) 874-9715
Mailing address
7400 S RACINE AVE, SUITE 101, CHICAGO, IL 60636-4114
(773) 874-9715
(773) 874-9715
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636560
BCBS PROVIDER NUMBER
IL
Enumeration date
03/19/2007
Last updated
07/08/2007
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