Provider Demographics
NPI:1760827620
Name:GREEN THERAPY AND CONSULTATION LLC
Entity Type:Organization
Organization Name:GREEN THERAPY AND CONSULTATION LLC
Other - Org Name:GREEN THERAPY AND CONSULTATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-364-5782
Mailing Address - Street 1:155 BIRDSALL ST APT 342
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8187
Mailing Address - Country:US
Mailing Address - Phone:713-364-5782
Mailing Address - Fax:346-214-6031
Practice Address - Street 1:155 BIRDSALL ST APT 342
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8187
Practice Address - Country:US
Practice Address - Phone:713-364-5782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76600101YP2500X
IL180008519101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty