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General NPI Number Information
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NPI Number | 1790590735
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Entity Type | Individual
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Provider Name | SHAWNA A. GREEN LAMFT
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Gender | Female
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 13584 N 144TH DR
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City | SURPRISE
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State | AZ
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Zip | 85379-6191
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Country | US
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Telephone | 602-819-1807
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8988
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City | SURPRISE
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State | AZ
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Zip | 85374-0133
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Country | US
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Telephone | 602-819-1807
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LAMFT-10993
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License Number State | AZ
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