Provider Demographics
NPI:1427481092
Name:GREEN, CHRIS (MA)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 100TH PL SE STE 200
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3865
Mailing Address - Country:US
Mailing Address - Phone:425-299-5148
Mailing Address - Fax:425-353-1987
Practice Address - Street 1:1720 100TH PL SE STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3865
Practice Address - Country:US
Practice Address - Phone:425-299-5148
Practice Address - Fax:425-353-1987
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60385105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health