Provider Demographics
NPI:1821102336
Name:GREEN, AMY BISHOP
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BISHOP
Last Name: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 1:8844 COOK RD
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MS
Mailing Address - Zip Code:39320-9520
Mailing Address - Country:US
Mailing Address - Phone:601-527-8855
Mailing Address - Fax:
Practice Address - Street 1:8844 COOK RD
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:MS
Practice Address - Zip Code:39320-9520
Practice Address - Country:US
Practice Address - Phone:601-527-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist