Healthcare Provider Details

I. General information

NPI: 1053884676
Provider Name (Legal Business Name): MONTREECE NICOLE GREEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 COUNTY ROAD 356
ADKINS TX
78101-2407
US

IV. Provider business mailing address

PO BOX 200764
SAN ANTONIO TX
78220-0764
US

V. Phone/Fax

Practice location:
  • Phone: 210-860-0637
  • Fax:
Mailing address:
  • Phone: 210-860-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number57821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: