Individual
MS. TIA JAELAINE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
407 W 15TH ST STE 7, EDMOND, OK 73013-3668
(405) 204-4677
(405) 604-0923
Mailing address
PO BOX 96301, OKLAHOMA CITY, OK 73143-6301
(405) 204-4677
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/12/2006
Last updated
08/28/2023
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