MEDICARE: GREEN THERAPY AND CONSULTATION LLC

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	76600	TX

General Provider Information

NPI Number	:	1760827620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN THERAPY AND CONSULTATION LLC

Provider Business Mailing Address
First Line	:	129 10TH ST
Second Line	:
City	:	CARMI
State	:	IL
Zip	:	62821-1309
Country	:	US
Telephone Number	:	713-364-5782
Fax Number	:	346-214-6031

Provider Business Practice Location Address
First Line	:	8203 RENMARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3620
Country	:	US
Telephone Number	:	713-364-5782
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDRA GREEN
Credential	:
Telephone Number	:	713-364-5782

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	05/21/2026

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