Provider Demographics
NPI:1245625144
Name:GREENE, GARY (LMFT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200-196
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6784
Mailing Address - Country:US
Mailing Address - Phone:760-969-5081
Mailing Address - Fax:
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200-196
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6784
Practice Address - Country:US
Practice Address - Phone:760-969-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111668106H00000X
CAIMF69752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty