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NPI Code Detail

MEDICARE: MANDY GREEN MS, LPC

MEDICARE: MANDY GREEN MS, LPC
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
1101YP2500XProfessional Counselor60995TX

General Provider Information

NPI Number : 1083887376
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY GREEN MS, LPC
Provider Business Mailing Address
First Line : 2800 KIRBY DR
Second Line : STE B427
City : HOUSTON
State : TX
Zip : 77098-1273
Country : US
Telephone Number : 713-562-3672
Fax Number :
Provider Business Practice Location Address
First Line : 4803 SAN FELIPE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77056-3907
Country : US
Telephone Number : 713-626-7990
Fax Number : 716-627-7715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2008
Last Update Date : 09/02/2010

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