Individual
JENNIFER JEAN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
458 HERNDON ST, SHREVEPORT, LA 71101-4859
(318) 221-5565
Mailing address
458 HERNDON ST, SHREVEPORT, LA 71101-4859
(318) 429-6938
(866) 825-9703
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600964601
—
LA
Enumeration date
02/14/2017
Last updated
09/13/2023
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