Provider Demographics
NPI:1699414995
Name:GREEN, ARIEL SIMONE
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:SIMONE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HIGHWAY 360 APT 5303
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5326
Mailing Address - Country:US
Mailing Address - Phone:817-739-0859
Mailing Address - Fax:
Practice Address - Street 1:2214 EMERY ST STE 510
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2476
Practice Address - Country:US
Practice Address - Phone:940-215-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health