Healthcare Provider Details

I. General information

NPI: 1497312367
Provider Name (Legal Business Name): KATHRYN M GREEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MAIN ST STE E
TEMPLETON CA
93465-9366
US

IV. Provider business mailing address

2178 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4535
US

V. Phone/Fax

Practice location:
  • Phone: 805-550-0594
  • Fax: 855-203-0699
Mailing address:
  • Phone: 805-781-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: