Provider Demographics
NPI:1639842586
Name:GREENE, KAMILLE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:KAMILLE
Middle Name:MARIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-0747
Mailing Address - Country:US
Mailing Address - Phone:785-587-4300
Mailing Address - Fax:
Practice Address - Street 1:1558 HAYES DRIVE
Practice Address - Street 2:MAILING ADDRESS 2
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6650
Practice Address - Country:US
Practice Address - Phone:785-587-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03206106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist