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General NPI Number Information
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NPI Number | 1376069534
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Entity Type | Individual
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Provider Name | LATISHA GREEN LPC-A / BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/19/2017
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 2417 EVENING STONE DR
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City | AUBREY
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State | TX
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Zip | 76227-1980
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Country | US
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Telephone | 940-600-7202
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Fax |
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Provider Business Mailing Address
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Address Line | 11450 US HIGHWAY 380 STE 130
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City | CROSS ROADS
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State | TX
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Zip | 76227-8322
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Country | US
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Telephone | 940-600-7202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 101156
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-26129
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License Number State |
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