MEDICARE: KIRBY GREEN LMSW

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	101YM0800X	Mental Health Counselor	112188	TX

General Provider Information

NPI Number	:	1467218644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRBY GREEN LMSW

Provider Business Mailing Address
First Line	:	5222 BRYANT IRVIN RD APT 1211
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3842
Country	:	US
Telephone Number	:	832-231-4945
Fax Number	:

Provider Business Practice Location Address
First Line	:	5222 BRYANT IRVIN RD APT 1211
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3842
Country	:	US
Telephone Number	:	832-231-4945
Fax Number	:

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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Directions to “ KIRBY GREEN LMSW” Practice Location

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