Active NPI
Charlene Kim Green, LMFT
- Marriage & Family Therapist
- Elk Grove, CA
National Provider Identifier
1760810691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 86299
- Practice address
- 9008 Elk Grove Blvd
Elk Grove, CA 95624-1945 - Phone
- (916) 544-0502
- Fax
- (916) 688-8603
- NPI assigned
- Nov 1, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 73224 | CA | |
| Marriage & Family Therapist | 106H00000X | 86299 | CA | Primary |
Addresses
Primary practice location
9008 Elk Grove Blvd
Elk Grove, CA 95624-1945
Mailing address
9008 Elk Grove Blvd
Elk Grove, CA 95624-1945
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 73224 | Other | CA | BOARD OF BEHAVIOR SCIENCES |
| 86299 | Other | CA | BOARD OF BEHAVIORAL SCIENCES |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73224 | CA | MD | Clinical Social Worker |
| 86299 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437091200000",
"number": "1760810691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9008 ELK GROVE BLVD",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956241945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9008 ELK GROVE BLVD",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956241945",
"telephone_number": "916-544-0502",
"fax_number": "916-688-8603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CHARLENE",
"middle_name": "KIM",
"name_prefix": "Mrs.",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-01",
"last_updated": "2015-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "73224",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "86299",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF BEHAVIOR SCIENCES",
"identifier": "73224",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF BEHAVIORAL SCIENCES",
"identifier": "86299",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.