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General NPI Number Information
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NPI Number | 1083585814
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Entity Type | Individual
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Provider Name | JON GREEN M.S.
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Gender |
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 1327 BERRY ST
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City | CALISTOGA
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State | CA
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Zip | 94515-1605
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Country | US
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Telephone | 707-709-2750
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 LAKE ST
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City | CALISTOGA
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State | CA
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Zip | 94515-1351
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Country | US
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Telephone | 707-709-2750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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