Randy Dale Green, MS, LAC
Individual provider Active NPI Mental Health Counselor · Fordyce, AR
NPI 1689804320 · NPPES record last updated Mar 25, 2021
Key facts
- NPI
- 1689804320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- P1109064 (AR)
- Practice address
- 1101 W 3Rd St
Fordyce, AR 71742-3014 - Phone
- (870) 352-5122
- Fax
- (870) 352-5127
- NPI assigned
- Jul 15, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P1109064 | AR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TFS of Gurdon Inc | Past |
Accepting new patients | |
| BHC Pinnacle Pointe Hospital LLC | Past | Accepting new patients | |
| Fordyce Counseling Clinic, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P1109064 | AR | Yes |
Addresses
Primary practice location
1101 W 3Rd St
Fordyce, AR 71742-3014
Mailing address
1101 W 3Rd St
Fordyce, AR 71742-3014
Phone (870) 352-5122
Other practice location 1
600 Main St Ste V
Hot Springs, AR 71913-4964
Phone (501) 321-8200
Other providers in Fordyce, AR
- Keri Lynn Freer
- Rylee Garner
- Sheena Garrard
- Erin Gehring
- Kreston Tyrell Gibbs
- Linda Griggs
- Habilitation Center, LLC
- Habilitation Center, LLC
- Paul Antonio Hall
- Nikki Linn Hardemon
All providers in Fordyce, AR · Mental Health Counselor in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.