Provider Demographics
NPI:1699806216
Name:GREEN, DOUGLAS (MFT, LPCC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:MFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 327
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7207
Mailing Address - Country:US
Mailing Address - Phone:818-624-3637
Mailing Address - Fax:818-905-1881
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 327
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7207
Practice Address - Country:US
Practice Address - Phone:818-624-3637
Practice Address - Fax:818-905-1881
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist