| Anita J Green, | |
|
905 Montgomery St, Decorah, IA 52101-2325 | |
| (563) 382-3649 | |
| Not Available |
| Full Name | Anita J Green |
|---|---|
| Gender | Female |
| Speciality | Counselor - Mental Health |
| Location | 905 Montgomery St, Decorah, Iowa |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255118485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 88187 (Texas) | Secondary |
| 101YM0800X | Counselor - Mental Health | 121744 (Iowa) | Primary |
| Entity Name | Northeast Iowa Mental Health Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1710933445 PECOS PAC ID: 1355230475 Enrollment ID: O20040315000839 |
| Mailing Address | Practice Location Address |
|---|---|
| Anita J Green, 905 Montgomery St, Decorah, IA 52101-2325 Ph: (563) 382-3649 | Anita J Green, 905 Montgomery St, Decorah, IA 52101-2325 Ph: (563) 382-3649 |
Yarrow Pasche, TLMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1111 Paine St, Decorah, IA 52101 Phone: 563-223-8466 | |
Ms. Wendy Buenzow, BA Counselor Medicare: Not Enrolled in Medicare Practice Location: 905 Montgomery St, Decorah, IA 52101 Phone: 563-382-3649 Fax: 563-382-8183 | |
Carol Hemesath, MS, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 709 Franklin St, Decorah, IA 52101 Phone: 563-387-0428 Fax: 563-387-0428 | |
Mr. Chad Michael Wikan, CADC Counselor Medicare: Not Enrolled in Medicare Practice Location: Po Box 349, Decorah, IA 52101 Phone: 563-382-3649 Fax: 563-382-8183 | |
Lisa Beatty, T-LMHC Counselor Medicare: Medicare Enrolled Practice Location: 905 Montgomery St, Decorah, IA 52101 Phone: 563-382-3649 | |
Robert Hinshaw Ii, T-LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 905 Montgomery St, Decorah, IA 52101 Phone: 563-382-3649 | |
Ms. Marcia Berkeland Oltrogge, MA, CADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 905 Montgomery St, Decorah, IA 52101 Phone: 563-382-3649 Fax: 563-382-8183 |