Individual
GRADIE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6701 SW BAYWOOD DR, LAWTON, OK 73505-9026
(580) 704-5521
(580) 585-4619
Mailing address
6701 SW BAYWOOD DR, LAWTON, OK 73505-9026
(580) 704-5521
(580) 585-4619
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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