Kimberly D. Green, M.ED, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LF00002194 Issued in WA

Practice address

667 Spring Drive Ext
Winston Salem, NC 27107-9788

Phone

(253) 225-5418

Fax

(877) 410-5513

NPI assigned

Nov 9, 2005

Last updated

Jul 7, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kim D. Green Other name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwest Psychological Services, Inc.

  • Clinical Psychologist
  • Gig Harbor, WA
  • NPI 1366786154
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1275514077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "667 SPRING DRIVE EXT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271079788",
            "telephone_number": "253-225-5418",
            "fax_number": "877-410-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 SPRING DRIVE EXT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271079788",
            "telephone_number": "253-225-5418",
            "fax_number": "877-410-5513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3220 Uddenberg Ln Ste 1",
            "address_purpose": "LOCATION",
            "city": "Gig Harbor",
            "state": "WA",
            "postal_code": "983355128",
            "country_code": "US",
            "telephone_number": "253-225-5418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KIMBERLY",
        "middle_name": "D.",
        "credential": "M.ED, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF00002194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1091299",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "GREEN",
            "middle_name": "D.",
            "credential": "M.ED, LMFT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Catherine Marie Green, MD
• Dana Frances Green, PA-C
• Diana Green, MSW, LCSW
• Ha Vo Green, PA-C
• Karen E Green, MD
• Lindsey Green
• Mary Elizabeth Green, LPN
• O'Ni Tanesha Josephine Green
• Patrick Daniel Green, MD
• Patti Green, LCSWA

• Marriage & Family Therapist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Marriage & Family Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.