MEDICARE: ALEXANDRA GREEN MS, LCPC, LPC

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	180008519	IL
2	101YP2500X	Professional Counselor	76600	TX

General Provider Information

NPI Number	:	1780936187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA GREEN MS, LCPC, LPC

Provider Business Mailing Address
First Line	:	129 10TH ST
Second Line	:
City	:	CARMI
State	:	IL
Zip	:	62821-1309
Country	:	US
Telephone Number	:	713-203-9061
Fax Number	:

Provider Business Practice Location Address
First Line	:	8203 RENMARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3620
Country	:	US
Telephone Number	:	713-203-9061
Fax Number	:

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	05/21/2026

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