PHYLLIS LOUISE GREEN (NPI# 1790909695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790909695 |
| Entity Type | Individual |
| Full Name | PHYLLIS LOUISE GREEN |
| Practice Address |
8026 Lorraine Ave Suite 201 Stockton CA 95210-4224 |
| Mailing Address |
4230 Giselle Ln Stockton CA 95206-6509 |
| Practice Telephone | 2096446328 |
| Practice Fax Number | 2096446308 |
| Mailing Telephone | 2095130247 |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902082035 | Phyllis Lavern Green | Case Manager/Care Coordinator | 10 Rachel Ct, Little Rock, AR 72206-5409 | 2008-01-18 |
| 1558331439 | Phyllis R Green | Nurse Practitioner | 3425 1st Ave Se, Suite 100, Cedar Rapids, IA 52402-6155 | 2006-01-24 |
| 1902308240 | Phyllis Green | Counselor | 2780 Sw 37th Ave Ste 206, Coconut Grove, FL 33133-2740 | 2018-03-02 |
| Street Address |
8026 LORRAINE AVE SUITE 201 |
| City | STOCKTON |
| State | CA |
| Zip Code | 95210-4224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487878476 | Frank Adolph Moscato Jr. | Counselor | 8026 Lorraine Ave, Suite 201, Stockton, CA 95210-4224 | 2007-04-12 |
| 1215152152 | Eric Jackson Sr. | Counselor | 8026 Lorraine Ave, Suite 201, Stockton, CA 95210-4224 | 2007-04-16 |
| 1912122250 | Service First of Northern California | Counselor | 8026 Lorraine Ave, Suite 201, Stockton, CA 95210-4224 | 2007-04-13 |
| 1154545143 | Jennifer Christine Collins | Counselor | 8026 Lorraine Ave, Suite 201, Stockton, CA 95210-4224 | 2007-04-12 |
| 1407070311 | Michelle Francine Rodrigues | Counselor | 8026 Lorraine Ave, Suite 201, Stockton, CA 95210-4224 | 2007-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063021970 | Leslie Jazmin Marin | Student in an Organized Health Care Education/Training Program | 7109 Danny Dr, Stockton, Stockton, CA 95210 | 2020-07-27 |
| 1043866692 | Alexis Thomasson | Behavior Technician | 7109 Danny Drive, Stockton, CA 95210 | 2019-08-09 |
| 1821651324 | Maria Guadalupe Toledo | Lactation Consultant, Non-RN | 7912 Hammer Lane, Stockton, CA 95210 | 2019-04-19 |
| 1508226440 | Active Life Adult Day Care, Inc. | Clinic/Center | 7209 Tam O'shanter Dr., Stockton, CA 95210 | 2016-03-04 |
| 1548631260 | Rachel Standley | Substance Abuse Rehabilitation Facility | 8017 El Cajon St, Stockton, CA 95210 | 2015-10-08 |
| 1225435308 | Active Life Medical Produtcs Inc | Durable Medical Equipment & Medical Supplies | 611 W Grider Way, Stockton, CA 95210 | 2014-12-04 |
| 1942633318 | Kimberly Ruiz Dizon | Physician Assistant | 1530 E Hammer Ln, Stockton, CA 95210 | 2013-08-20 |
| 1285920983 | Supplemental Health Care | Preferred Provider Organization | 8425 Kiltie Wy, Stockton, CA 95210 | 2011-06-22 |
| 1770807901 | Stockton Medical Weight Loss Center Inc | Internal Medicine | 1801 E. March Lane, Suite 400d, Stockton, CA 95210 | 2010-03-17 |
| 1699911412 | Pratap Krishna Anne | Pharmacist | 1801 E.march Ln, Suite:b280, Bjrx, Stockton, CA 95210 | 2008-12-29 |
| Find all providers in zip 95210 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740893155 | Tracey Black | Counselor | 130 W Flora St, Stockton, CA 95202-1636 | 2020-08-25 |
| 1699305508 | Juan Robles | Counselor | 1947 N California St # 95204, Stockton, CA 95204-6029 | 2020-01-20 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1821648353 | Kaye Lynn Scott-roy | Counselor | 285 H Rd, Stockton, KS 67669-8889 | 2019-09-17 |
| 1760049043 | Jay Frank Williams | Counselor | 1105 N El Dorado St, Stockton, CA 95202-1305 | 2019-05-22 |
| 1184105462 | Rachelle Diane Wilson | Counselor | 2733 N Sutter St, Stockton, CA 95204-4548 | 2018-08-24 |
| 1568943835 | Heather Lynn Rogers | Counselor | 3990 Black Butte Cir, Stockton, CA 95209-3500 | 2018-08-24 |
| 1235631722 | Parker Yang | Counselor | 1111 N. El Dorado St, Stockton, CA 95202 | 2018-03-01 |
| 1487162087 | Linda Soun | Counselor | 1111 N. El Dorado Street, Stockton, CA 95202 | 2018-01-17 |
| 1760995781 | Dana Lamont Harris | Counselor | 2833 Buckner Ct, Stockton, CA 95207-2302 | 2017-11-13 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.