Healthcare Provider Details

I. General information

NPI: 1336576040
Provider Name (Legal Business Name): KERRI D. GREEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 LANG AVE NE STE 110
ALBUQUERQUE NM
87109-4475
US

IV. Provider business mailing address

4801 LANG AVE NE SUITE 110 PMB 3041
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-519-0779
  • Fax:
Mailing address:
  • Phone: 505-519-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2023-0299
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT100413
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: