Individual
WESLEY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3340 LAKE CENTER DR APT 12107, MOUNT DORA, FL 32757-2378
(352) 800-9172
Mailing address
3340 LAKE CENTER DR APT 12107, MOUNT DORA, FL 32757-2378
(352) 800-9172
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Enumeration date
07/31/2020
Last updated
07/31/2020
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