Healthcare Provider Details

I. General information

NPI: 1265298251
Provider Name (Legal Business Name): JENNIFER GREENE LMFT, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORONADO ST
EL GRANADA CA
94018-8051
US

IV. Provider business mailing address

PO BOX 1671
EL GRANADA CA
94018-1671
US

V. Phone/Fax

Practice location:
  • Phone: 559-473-7521
  • Fax:
Mailing address:
  • Phone: 559-473-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER L GREENE
Title or Position: THERAPIST
Credential: LMFT 126229
Phone: 559-473-7521