Provider Demographics
NPI:1780261552
Name:GREEN, AMBER JANIELLE (MS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JANIELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JANIELLE
Other - Last Name:LATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:9718 AIELLO LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7440
Mailing Address - Country:US
Mailing Address - Phone:318-638-9945
Mailing Address - Fax:
Practice Address - Street 1:2912 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-4934
Practice Address - Country:US
Practice Address - Phone:318-626-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8418171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator