Individual ProviderFred GreenCounselorBehavioral Health & Social Service ProvidersPractice Address10373 NE Hancock St, Portland, OR 97220-3873(503) 253-6754PECOS EnrollmentBased on the most recent information from CMS, provider Fred Green does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1265841225Provider TypeIndividualFull NameGreen, FredGenderMaleSole ProprietorNoEnumeration Date8/4/2014Last Updated8/4/2014Contact InformationPractice LocationPractice Address10373 NE Hancock St, Portland, OR 97220-3873Phone(503) 253-6754FaxUnlisted FaxMailing LocationMailing AddressPO Box 8459, Portland, OR 97207-8459PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer