Healthcare Provider Details

I. General information

NPI: 1598146722
Provider Name (Legal Business Name): COURTNEY LEE GREEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 W HOLLAND AVE
CLOVIS CA
93612-4800
US

IV. Provider business mailing address

312 5TH ST STE B
CLOVIS CA
93612-1058
US

V. Phone/Fax

Practice location:
  • Phone: 559-538-1230
  • Fax:
Mailing address:
  • Phone: 559-712-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: