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NPI Code Detail

MEDICARE: SHANTEL GREEN

MEDICARE: SHANTEL GREEN
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
11041C0700XClinical Social Worker106566TX

General Provider Information

NPI Number : 1396573580
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTEL GREEN
Provider Business Mailing Address
First Line : 1751 RIVER RUN STE 200
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-6670
Country : US
Telephone Number : 817-500-0785
Fax Number : 817-241-1963
Provider Business Practice Location Address
First Line : 4500 MERCANTILE PLAZA DR STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4206
Country : US
Telephone Number : 817-482-0537
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2024
Last Update Date : 12/16/2025

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Directions to “ SHANTEL GREEN ” Practice Location

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