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1952343196
TIA JAELAINE GREEN
EDMOND, OK
NPI
1952343196
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
Enumeration Date
2006-06-12
Last Update Date
2023-08-28
Business Address
Ms. TIA JAELAINE GREEN LCSW
407 W 15TH ST STE 7
EDMOND, OK 73013-3668
Phone number: 405-204-4677
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Mailing Address
Ms. TIA JAELAINE GREEN LCSW
PO BOX 96301
OKLAHOMA CITY, OK 73143-6301
Phone number: 405-204-4677
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