MEDICARE: TAWNIE MICHELLE GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-82416	TX
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1851057657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWNIE MICHELLE GREEN

Provider Business Mailing Address
First Line	:	14100 SAN PEDRO AVE STE 412
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2009
Country	:	US
Telephone Number	:	210-281-8669
Fax Number	:	210-314-5044

Provider Business Practice Location Address
First Line	:	12758 CIMARRON PATH STE 127
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3498
Country	:	US
Telephone Number	:	855-374-4900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	10/16/2025

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Directions to “ TAWNIE MICHELLE GREEN ” Practice Location

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