MEDICARE: LATISHA GREEN LPC-A / BCBA

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	101156	TX
2	103K00000X	Behavior Analyst	1-17-26129

General Provider Information

NPI Number	:	1376069534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISHA GREEN LPC-A / BCBA

Provider Business Mailing Address
First Line	:	11450 US HIGHWAY 380 STE 130
Second Line	:
City	:	CROSS ROADS
State	:	TX
Zip	:	76227-8322
Country	:	US
Telephone Number	:	940-600-7202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 EVENING STONE DR
Second Line	:
City	:	AUBREY
State	:	TX
Zip	:	76227-1980
Country	:	US
Telephone Number	:	940-600-7202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2017
Last Update Date	:	03/02/2026

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