Healthcare Provider Details

I. General information

NPI: 1841124955
Provider Name (Legal Business Name): CHRISTOPHER G GREEN AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

12250 SW 2ND ST STE B
BEAVERTON OR
97005-2828
US

IV. Provider business mailing address

12250 SW 2ND ST STE B
BEAVERTON OR
97005-2828
US

V. Phone/Fax

Practice location:
  • Phone: 619-341-9296
  • Fax:
Mailing address:
  • Phone: 619-341-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR8998
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: