Provider Demographics
NPI:1346939915
Name:GREEN, EMELIE
Entity type:Individual
Prefix:
First Name:EMELIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W TOWN AND COUNTRY RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4633
Mailing Address - Country:US
Mailing Address - Phone:949-357-2556
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:1100 W TOWN AND COUNTRY RD STE 1250
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4633
Practice Address - Country:US
Practice Address - Phone:949-357-2556
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-06-07
Deactivation Date:2023-11-15
Deactivation Code:
Reactivation Date:2024-06-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician