Healthcare Provider Details

I. General information

NPI: 1851069561
Provider Name (Legal Business Name): GREENLINE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 MORSE AVE
PLACENTIA CA
92870-3415
US

IV. Provider business mailing address

170 E YORBA LINDA BLVD # 226
PLACENTIA CA
92870-3327
US

V. Phone/Fax

Practice location:
  • Phone: 949-478-0665
  • Fax:
Mailing address:
  • Phone: 714-335-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT PATE
Title or Position: OWNER
Credential: PSYD
Phone: 714-335-9265