Provider Demographics
NPI:1669268462
Name:GREEN, AMANDA ROSE (CRADC, LMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:GREEN
Suffix:
Gender:
Credentials:CRADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 STATE HWY Z
Mailing Address - Street 2:
Mailing Address - City:HALFWAY
Mailing Address - State:MO
Mailing Address - Zip Code:65663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2728 E CHESTNUT EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2555
Practice Address - Country:US
Practice Address - Phone:417-848-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023044670106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist