Provider Demographics
NPI:1295018208
Name:GREEN, JOSHUA L (LAC, EAMP, MQP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:GREEN
Suffix:
Gender:M
Credentials:LAC, EAMP, MQP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3096
Mailing Address - Country:US
Mailing Address - Phone:425-256-7798
Mailing Address - Fax:425-274-3409
Practice Address - Street 1:611 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3096
Practice Address - Country:US
Practice Address - Phone:425-256-7798
Practice Address - Fax:425-274-3409
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR155797171100000X
WAAC60244418171100000X
HI1105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist