MEDICARE: DESTINY JOY GREEN LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1689149817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY JOY GREEN LCSW

Provider Business Mailing Address
First Line	:	5870 HIGHWAY 6 N STE 311
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1857
Country	:	US
Telephone Number	:	832-280-4054
Fax Number	:	832-280-9919

Provider Business Practice Location Address
First Line	:	5870 HIGHWAY 6 N STE 311
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1857
Country	:	US
Telephone Number	:	832-280-4054
Fax Number	:	832-280-9919

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

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/09/2019

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