Provider Demographics
NPI:1407231657
Name:GREEN, TINA LINETTE (MS, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:LINETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 KIMBERLINA RD.
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280
Mailing Address - Country:US
Mailing Address - Phone:661-758-4402
Mailing Address - Fax:661-758-0891
Practice Address - Street 1:2821 H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1913
Practice Address - Country:US
Practice Address - Phone:661-381-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF85769106H00000X
CA122864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000001588Medicare UPIN