MEDICARE: MS. TINISIA L GREEN LAC.

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	171100000X	Acupuncturist	AC01299	TX

General Provider Information

NPI Number	:	1457628992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TINISIA L GREEN LAC.

Provider Business Mailing Address
First Line	:	1601 E. LAMAR #218A
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011
Country	:	US
Telephone Number	:	817-235-9467
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 E LAMAR BLVD STE 218A
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-4464
Country	:	US
Telephone Number	:	817-235-9467
Fax Number	:

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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