Healthcare Provider Details

I. General information

NPI: 1700170008
Provider Name (Legal Business Name): JENNIFER L. GREENE LMFT 126229
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1671
EL GRANADA CA
94018-1671
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 Number126229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: