MEDICARE: GREEN SHORE COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053108951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN SHORE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	PO BOX 413
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77410-0413
Country	:	US
Telephone Number	:	281-378-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	11803 GRANT RD STE 209
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-4022
Country	:	US
Telephone Number	:	281-378-7912
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JONATHAN CAESAR
Credential	:	LPC
Telephone Number	:	281-378-7912

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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Directions to “GREEN SHORE COUNSELING PLLC ” Practice Location

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