Most Relevant Information
Provider Data
| NPI Number: | 1003321753 |
| Provider Name: | MATHIAS M GREEN |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/04/2017 |
| Last Updated: | 05/20/2019 |
Provider Practice Location
419 E 7TH ST STE 207
THE DALLES
OR
970582676
Practice Location Phone/Fax
| Phone: | 5412965452 |
| Fax: | 5412961537 |
Provider Mailing Location
3587 HEATHROW WAY
MEDFORD
OR
975044004
Provider Mailing Phone/Fax
| Phone: | 5418588170 |
| Fax: | 5418588167 |