| Dana Boldt Green, M.ed., Lpc, Ncgc-2, Pc | |
|
8800 Birch St Kingston OK 73439 | |
| (580) 565-2252 | |
| Not Available |
| Full Name | Dana Boldt Green, M.ed., Lpc, Ncgc-2, Pc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 8800 Birch St, Kingston, Oklahoma |
| Authorized Official Name and Position | Dana Green (PRESIDENT) |
| Authorized Official Contact | 58505652252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dana Boldt Green, M.ed., Lpc, Ncgc-2, Pc Po Box 1800 Kingston OK 73439-1800 Ph: (580) 565-2252 | Dana Boldt Green, M.ed., Lpc, Ncgc-2, Pc 8800 Birch St Kingston OK 73439 Ph: (580) 565-2252 |
| NPI Number | 1518373513 |
|---|---|
| Provider Enumeration Date | 07/10/2014 |
| Last Update Date | 07/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518373513 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2011 (Oklahoma) | Primary |
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