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NPI Code Detail

MEDICARE: MR. DOUGLAS GREEN MFT, LPCC

MEDICARE: MR. DOUGLAS GREEN MFT, LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist47730CA

General Provider Information

NPI Number : 1699806216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS GREEN MFT, LPCC
Provider Business Mailing Address
First Line : 12304 SANTA MONICA BLVD STE 327
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7207
Country : US
Telephone Number : 818-624-3637
Fax Number : 818-905-1881
Provider Business Practice Location Address
First Line : 12304 SANTA MONICA BLVD STE 327
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7207
Country : US
Telephone Number : 818-624-3637
Fax Number : 818-905-1881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 03/25/2024

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