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General NPI Number Information
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NPI Number | 1780936187
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Entity Type | Individual
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Provider Name | ALEXANDRA GREEN MS, LCPC, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 8203 RENMARK LN
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City | HOUSTON
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State | TX
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Zip | 77070-3620
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Country | US
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Telephone | 713-203-9061
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Fax |
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Provider Business Mailing Address
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Address Line | 129 10TH ST
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City | CARMI
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State | IL
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Zip | 62821-1309
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Country | US
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Telephone | 713-203-9061
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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 | 180008519
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 76600
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License Number State | TX
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