Provider Demographics
NPI:1477906048
Name:DR. MARSHA A. GREEN, L.L.C.
Entity Type:Organization
Organization Name:DR. MARSHA A. GREEN, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-728-8546
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-0494
Mailing Address - Country:US
Mailing Address - Phone:503-728-8546
Mailing Address - Fax:844-640-2822
Practice Address - Street 1:710C FOOTHILLS DR, STE 104
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132
Practice Address - Country:US
Practice Address - Phone:503-728-8546
Practice Address - Fax:844-640-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR122027899251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health