Kimberly Nicole Green-Russell, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

80853 Issued in CA

Practice address

510 S. Vermont Avenue
Los Angeles, CA 90020-1912

Phone

(213) 842-0333

NPI assigned

Feb 17, 2012

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 names 1

• Kimberly Nicole Green Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1407129687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88591",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900098591",
            "telephone_number": "323-513-3428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S. VERMONT AVENUE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900201912",
            "telephone_number": "213-842-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN-RUSSELL",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-17",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "80853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "GREEN",
            "middle_name": "NICOLE",
            "credential": "LMFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Green Cross Med Net Inc
• Green Dot Public Schools
• Green Line Home Care Inc
• Green Oak Ventures
• Erin Rebecca Green-Krogmann, PH.D
• Abe Green, MD
• Alexa Harcourt Green, RN
• Alexander Green
• Allen H Green, M.D.
• Amari-Denzil Sade Green

• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.