Provider Demographics
NPI:1609149798
Name:GREEN, FAY H (LPC; LMFT)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:H
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 591848
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0142
Mailing Address - Country:US
Mailing Address - Phone:210-602-7488
Mailing Address - Fax:210-610-9848
Practice Address - Street 1:21270 HARDY OAK BLVD, STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4835
Practice Address - Country:US
Practice Address - Phone:210-602-7488
Practice Address - Fax:210-610-9848
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201589106H00000X
TX66042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist