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General NPI Number Information
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NPI Number | 1396573580
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Entity Type | Individual
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Provider Name | SHANTEL GREEN
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Gender | Female
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 4500 MERCANTILE PLAZA DR STE 300
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City | FORT WORTH
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State | TX
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Zip | 76137-4206
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Country | US
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Telephone | 817-482-0537
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Fax |
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Provider Business Mailing Address
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Address Line | 1751 RIVER RUN STE 200
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City | FORT WORTH
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State | TX
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Zip | 76107-6670
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Country | US
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Telephone | 817-500-0785
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Fax | 817-241-1963
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 106566
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License Number State | TX
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