Provider Demographics
NPI:1790809580
Name:GREEN, HERMAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
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 1:5862 CROMO DR
Mailing Address - Street 2:SUITE 147
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5551
Mailing Address - Country:US
Mailing Address - Phone:915-544-4267
Mailing Address - Fax:915-544-4267
Practice Address - Street 1:5862 CROMO DR
Practice Address - Street 2:SUITE 147
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5551
Practice Address - Country:US
Practice Address - Phone:915-544-4267
Practice Address - Fax:915-544-4267
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC- 06880101YM0800X
TXFELLOW- AAPC101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83679LOtherBLUE CROSS BLUE SHIELD