Provider Demographics
NPI:1659713576
Name:GREEN, AMBER R (MS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:R
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32210 US HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-2406
Mailing Address - Country:US
Mailing Address - Phone:605-685-8097
Mailing Address - Fax:
Practice Address - Street 1:32210 US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-2406
Practice Address - Country:US
Practice Address - Phone:605-685-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health