Provider Demographics
NPI:1396017943
Name:GREEN, DAVID ALAN (LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:GREEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 BRAESVALLEY DR APT 800
Mailing Address - Street 2:N/A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3277
Mailing Address - Country:US
Mailing Address - Phone:713-721-3151
Mailing Address - Fax:
Practice Address - Street 1:5415 BRAESVALLEY DR APT 800
Practice Address - Street 2:N/A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3277
Practice Address - Country:US
Practice Address - Phone:713-721-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66006101Y00000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171W00000XOther Service ProvidersContractor