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General NPI Number Information
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NPI Number | 1841951472
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Entity Type | Individual
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Provider Name | EMILY ROSE GREEN M.A. MG61142666
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Gender | Female
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 1601 116TH AVE NE SUITE 102
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City | BELLEVUE
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State | WA
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Zip | 98004-3010
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Country | US
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Telephone | 425-616-2775
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 116TH AVE NE SUITE 102
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City | BELLEVUE
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State | WA
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Zip | 98004
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Country | US
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Telephone | 425-616-2775
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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 | MG61142666
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License Number State | WA
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