Provider Demographics
NPI:1972723617
Name:GREEN, RICHARD BERNARD (LMHC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BERNARD
Last Name:GREEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:151 FINCH PL SW STE C
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2588
Mailing Address - Country:US
Mailing Address - Phone:206-696-1357
Mailing Address - Fax:
Practice Address - Street 1:151 FINCH PL SW STE C
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2588
Practice Address - Country:US
Practice Address - Phone:206-696-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health