Provider Demographics
NPI:1508985839
Name:GREEN, ANNE SAN JUAN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:SAN JUAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28562 OSO PKWY
Mailing Address - Street 2:#D-427
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5595
Mailing Address - Country:US
Mailing Address - Phone:949-291-3022
Mailing Address - Fax:
Practice Address - Street 1:27 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:TRABUCO CYN
Practice Address - State:CA
Practice Address - Zip Code:92679-5316
Practice Address - Country:US
Practice Address - Phone:949-291-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237228780101YA0400X
CAIMF 41797225400000X
CAMFC 46764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner