Healthcare Provider Details

I. General information

NPI: 1477906048
Provider Name (Legal Business Name): DR. MARSHA A. GREEN, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710C FOOTHILLS DR, STE 104
NEWBERG OR
97132
US

IV. Provider business mailing address

PO BOX 494
NEWBERG OR
97132-0494
US

V. Phone/Fax

Practice location:
  • Phone: 503-728-8546
  • Fax: 844-640-2822
Mailing address:
  • Phone: 503-728-8546
  • Fax: 844-640-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number122027899
License Number StateOR

VIII. Authorized Official

Name: DR. MARSAH ANN GREEN
Title or Position: OWNER
Credential: PSY.D.
Phone: 503-728-8546