Provider Demographics
NPI:1558910307
Name:GREENE, AMBER LEA (AMFT)
Entity type:Individual
Prefix:
First Name:AMBER LEA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMFT
Mailing Address - Street 1:101 S B ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6933
Mailing Address - Country:US
Mailing Address - Phone:053-354-1418
Mailing Address - Fax:
Practice Address - Street 1:101 S B ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6933
Practice Address - Country:US
Practice Address - Phone:053-354-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145874106H00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA145874OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES