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General NPI Number Information
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NPI Number | 1851069561
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Entity Type | Organization
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Legal Business Name | GREENLINE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 539 MORSE AVE
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City | PLACENTIA
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State | CA
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Zip | 92870-3415
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Country | US
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Telephone | 949-478-0665
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Fax |
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Provider Business Mailing Address
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Address Line | 170 E YORBA LINDA BLVD # 226
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City | PLACENTIA
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State | CA
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Zip | 92870-3327
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Country | US
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Telephone | 714-335-9265
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT PATE
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Credential | PSYD
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Telephone | 714-335-9265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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