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General NPI Number Information
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NPI Number | 1720967565
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Entity Type | Individual
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Provider Name | AMANDA GREEN LAC, NCC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 11/09/2025
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Provider Practice Location Address
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Address Line | 2200 E WILLIAMS FIELD RD STE 200
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City | GILBERT
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State | AZ
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Zip | 85295-0764
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Country | US
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Telephone | 480-710-0713
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Fax |
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Provider Business Mailing Address
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Address Line | 4129 S MARTINGALE RD
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City | GILBERT
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State | AZ
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Zip | 85297-8210
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Country | US
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Telephone | 480-710-0713
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-23558
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License Number State | AZ
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