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General NPI Number Information
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NPI Number | 1821413758
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Entity Type | Individual
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Provider Name | MS. AMY MARIE GREEN
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Gender | Female
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Dates
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Enumeration Date | 03/01/2014
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Last Update Date | 03/01/2014
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Provider Practice Location Address
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Address Line | 212 I ST
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City | DAVIS
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State | CA
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Zip | 95616-4213
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Country | US
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Telephone | 530-601-5959
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Fax |
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Provider Business Mailing Address
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Address Line | 28425 N BLACK CANYON HWY UNIT 2088
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City | PHOENIX
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State | AZ
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Zip | 85085-7601
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Country | US
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Telephone | 480-404-0716
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CA
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