Active NPI
Jerry Eugene Green, M.A.
- Professional Counselor
- Renton, WA
National Provider Identifier
1447439690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- RC00015663
- Practice address
- 15 S Grady Way Ste 310
Renton, WA 98057-3215 - Phone
- (425) 652-1886
- NPI assigned
- Oct 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | RC00015663 | WA | Primary |
Addresses
Primary practice location
15 S Grady Way Ste 310
Renton, WA 98057-3215
Mailing address
7832 196TH St SW
#15
Edmonds, WA 98026-6556
Phone (425) 652-1886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RC00015663 | WA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562889600000",
"number": "1447439690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7832 196TH ST SW",
"address_2": "#15",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980266556",
"telephone_number": "425-652-1886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 S GRADY WAY STE 310",
"city": "RENTON",
"state": "WA",
"postal_code": "980573215",
"telephone_number": "425-652-1886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JERRY",
"middle_name": "EUGENE",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-24",
"last_updated": "2019-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WA",
"license": "RC00015663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.