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General NPI Number Information
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NPI Number | 1376602110
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Entity Type | Individual
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Provider Name | DARYL GREEN LPC LMFT NCC
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Gender | Male
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 1805 FLORENCE RD SUITE 10
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City | KILLEEN
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State | TX
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Zip | 76541-8523
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Country | US
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Telephone | 254-526-5389
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Fax | 254-526-4853
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Provider Business Mailing Address
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Address Line | PO BOX 416
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City | TEMPLE
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State | TX
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Zip | 76503-0416
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Country | US
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Telephone | 254-774-8806
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Fax | 254-774-9672
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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 | 13560
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4672
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License Number State | TX
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