Provider Demographics
NPI:1891358867
Name:CHRISTINA L. GREEN, PMHNP-BC, PLLC
Entity Type:Organization
Organization Name:CHRISTINA L. GREEN, PMHNP-BC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP
Authorized Official - Phone:903-454-1700
Mailing Address - Street 1:4702 WESLEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5663
Mailing Address - Country:US
Mailing Address - Phone:903-454-1700
Mailing Address - Fax:903-454-1701
Practice Address - Street 1:3101 JOE RAMSEY BLVD E STE 104
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7762
Practice Address - Country:US
Practice Address - Phone:903-454-1700
Practice Address - Fax:903-454-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty