Provider Demographics
NPI:1285790485
Name:GREEN, LYN RIVAS (LMHC)
Entity type:Individual
Prefix:
First Name:LYN
Middle Name:RIVAS
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34581
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1581
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:5002 KITSAP WAY
Practice Address - Street 2:#206
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2359
Practice Address - Country:US
Practice Address - Phone:509-241-7349
Practice Address - Fax:509-241-7628
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007864101YM0800X
WARC00027519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8539561Medicaid