William Mack Green, LCSW, LSAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4932942-3501 Issued in UT

Practice address

107 N Main St
Bountiful, UT 84010-6162

Phone

(801) 244-5166

NPI assigned

Dec 19, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261180800000",
    "number": "1013246131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 E CENTER ST",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840142305",
            "telephone_number": "801-244-5166",
            "fax_number": "801-295-2618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N MAIN ST",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106162",
            "telephone_number": "801-244-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "WILLIAM",
        "middle_name": "MACK",
        "credential": "LCSW, LSAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-19",
        "last_updated": "2009-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "4932942-6006",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "4932942-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Jess Grant-Reynolds
• Madison Grant
• Abigail Lauren Gray
• Brianna Green, CMHC, MT-BC
• Larry Green
• Douglas Allan Greene, PA-C
• Elaina Scott Gregerson, PT, DPT
• Gregory D Hammond MD PC
• Jasmine Griffin
• Heidi Caroline Hopkins Grigg, RD, MDA

• Clinical Social Worker in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.