Johnny Duane Green
Individual provider Active NPI Counselor · Madill, OK
NPI 1831411263 · NPPES record last updated Feb 26, 2010
Key facts
- NPI
- 1831411263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 105 Plaza
Madill, OK 73446-2248 - Phone
- (580) 795-7439
- NPI assigned
- Feb 26, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240125001414 | OK | Practitioner - Mental Health Counselor | 4880047927 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthouse Behavioral Wellness Centers | Current | Accepting new patients | |
| Lighthouse Behavioral Wellness Centers | Current |
Accepting new patients | |
| Johnny D Green MSHR, LPC,PC | Past | Accepting new patients |
Locations
2530 S Commerce St
Bldg B
Ardmore, OK 73401
Phone (580) 319-7305
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
105 Plaza
Madill, OK 73446-2248
Mailing address
PO Box 1427
Ardmore, OK 73402-1427
Phone (580) 277-5423
Other providers in Madill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.