Healthcare Provider Details

I. General information

NPI: 1386554590
Provider Name (Legal Business Name): JOLIE MICHELLE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 15TH AVE SE STE 100
PUYALLUP WA
98372-3709
US

IV. Provider business mailing address

16471 SE 225TH ST
KENT WA
98042-7208
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-5200
  • Fax:
Mailing address:
  • Phone: 206-450-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: