Provider Demographics
NPI:1881199230
Name:GREEN, JONI (LMFT)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:GREEN
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 1:2855 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1133
Mailing Address - Country:US
Mailing Address - Phone:209-668-9361
Mailing Address - Fax:209-668-0539
Practice Address - Street 1:2855 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1133
Practice Address - Country:US
Practice Address - Phone:209-668-9361
Practice Address - Fax:209-668-0539
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist