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General NPI Number Information
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NPI Number | 1689818411
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Entity Type | Individual
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Provider Name | MARY SUE GREEN LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 8150 US HIGHWAY 287
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City | CHILDRESS
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State | TX
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Zip | 79201-7152
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Country | US
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Telephone | 940-536-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 804 COMBS ST
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City | QUANAH
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State | TX
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Zip | 79252-4444
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Country | US
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Telephone | 940-536-3644
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000311
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 201547
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License Number State | TX
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