Provider Demographics
NPI:1548793078
Name:BIANCHI-GREEN, MICHELLE L
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BIANCHI-GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 SE EVERETT MALL WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3743
Mailing Address - Country:US
Mailing Address - Phone:425-353-5656
Mailing Address - Fax:425-513-2807
Practice Address - Street 1:906 SE EVERETT MALL WAY
Practice Address - Street 2:STE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-353-5656
Practice Address - Fax:425-513-2807
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60316986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2078201Medicaid