Jalicia Chanel Green, CBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

61441058 Issued in WA

Practice address

615 S Division St Ste a
Moses Lake, WA 98837-3800

Phone

(509) 764-6644

Fax

(509) 764-6676

NPI assigned

Dec 25, 2023

Last updated

Dec 25, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1703462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703462400000",
    "number": "1982473542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S DIVISION ST STE A",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988373800",
            "telephone_number": "509-764-6644",
            "fax_number": "509-764-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S DIVISION ST STE A",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988373800",
            "telephone_number": "509-764-6644",
            "fax_number": "509-764-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JALICIA",
        "middle_name": "CHANEL",
        "name_prefix": "Miss",
        "credential": "CBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-25",
        "last_updated": "2023-12-25",
        "certification_date": "2023-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WA",
            "license": "61441058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Technician in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• Behavior Technician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.