| Jim Green Counseling, P.a. | |
|
47 Main Street Suite 230 Bangor ME 04401 | |
| (207) 941-1663 | |
| (207) 941-0077 |
| Full Name | Jim Green Counseling, P.a. |
|---|---|
| Speciality | Counselor |
| Location | 47 Main Street, Bangor, Maine |
| Authorized Official Name and Position | James William Green (PROVIDER) |
| Authorized Official Contact | 2079411663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jim Green Counseling, P.a. 47 Main Street Suite 230 Bangor ME 04401 Ph: (207) 941-1663 | Jim Green Counseling, P.a. 47 Main Street Suite 230 Bangor ME 04401 Ph: (207) 941-1663 |
| NPI Number | 1386035566 |
|---|---|
| Provider Enumeration Date | 02/10/2015 |
| Last Update Date | 02/10/2015 |
| Medicare PECOS PAC ID | 3678892049 |
|---|---|
| Medicare Enrollment ID | O20150506001868 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386035566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LC5061 (Maine) | Primary |
| Provider Name | James W Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386653012 PECOS PAC ID: 8729036447 Enrollment ID: I20050110000845 |
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