Provider Demographics
NPI:1073120127
Name:GARY GREENE, LMFT
Entity Type:Organization
Organization Name:GARY GREENE, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-872-4853
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-1398
Mailing Address - Country:US
Mailing Address - Phone:310-872-4853
Mailing Address - Fax:
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200-196
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6784
Practice Address - Country:US
Practice Address - Phone:760-969-5081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty