Healthcare Provider Details

I. General information

NPI: 1306105424
Provider Name (Legal Business Name): NICOLE TRENE GREEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 TRANQUIL MEADOWS DR NE
RIO RANCHO NM
87144-7302
US

IV. Provider business mailing address

3816 TRANQUIL MEADOWS DR NE
RIO RANCHO NM
87144-7302
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-1069
  • Fax: 844-714-2499
Mailing address:
  • Phone: 505-903-0387
  • Fax: 844-714-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0162171
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: