Active NPI
Jason Dwin Green, ED.D,HON. D.COUNS
- Pastoral Counselor
- North Las Vegas, NV
National Provider Identifier
1124904529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- 18090
- Practice address
- 5616 Grandmother Hat St
North Las Vegas, NV 89081-6467 - Phone
- (310) 597-0282
- NPI assigned
- Aug 12, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 18090 | TX | Primary |
| Health & Wellness Coach | 171400000X |
Addresses
Primary practice location
5616 Grandmother Hat St
North Las Vegas, NV 89081-6467
Mailing address
5616 Grandmother Hat St
North Las Vegas, NV 89081-6467
Phone (310) 597-0282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18090 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754956800000",
"number": "1124904529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5616 GRANDMOTHER HAT ST",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890816467",
"telephone_number": "310-597-0282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5616 GRANDMOTHER HAT ST",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890816467",
"telephone_number": "310-597-0282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JASON",
"middle_name": "DWIN",
"credential": "ED.D,HON. D.COUNS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-12",
"last_updated": "2025-08-12",
"certification_date": "2025-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "TX",
"license": "18090",
"primary": true
},
{
"code": "171400000X",
"taxonomy_group": "",
"desc": "Health & Wellness Coach",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.