Provider Demographics
NPI:1437928991
Name:GREEN, SHARILYN O (MFTI)
Entity Type:Individual
Prefix:
First Name:SHARILYN
Middle Name:O
Last Name:GREEN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 S 900 E STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7003
Mailing Address - Country:US
Mailing Address - Phone:435-619-5631
Mailing Address - Fax:
Practice Address - Street 1:736 S 900 E STE 201
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7003
Practice Address - Country:US
Practice Address - Phone:385-777-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8520440-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist