Individual
MARYBETH GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
4515 HIBISCUS ST, FORT COLLINS, CO 80526-4137
(970) 231-4077
Mailing address
PO BOX 270918, FORT COLLINS, CO 80527-0918
(970) 599-1015
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0001845
CO
Other
Enumeration date
07/05/2021
Last updated
07/05/2021
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