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General NPI Number Information
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NPI Number | 1407203540
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Entity Type | Individual
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Provider Name | MARGARET MARIE GREEN PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 7905 N MEADOWLARK WAY STE E
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City | COEUR D ALENE
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State | ID
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Zip | 83815-5041
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Country | US
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Telephone | 208-907-6441
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Fax | 208-209-6011
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Provider Business Mailing Address
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Address Line | PO BOX 1482
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City | HAYDEN
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State | ID
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Zip | 83835-1482
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Country | US
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Telephone | 208-907-6441
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Fax | 208-209-6011
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 202941
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60655201
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License Number State | WA
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