Provider Demographics
NPI:1275701096
Name:GREEN - SCOTT, ALICIA RENEE (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:RENEE
Last Name:GREEN - SCOTT
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15126 WESTERN SKIES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-1111
Mailing Address - Country:US
Mailing Address - Phone:281-808-2753
Mailing Address - Fax:
Practice Address - Street 1:2500 E T C JESTER BLVD STE 263
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1469
Practice Address - Country:US
Practice Address - Phone:281-808-2753
Practice Address - Fax:866-658-6264
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1898736-01Medicaid