Provider Demographics
NPI:1982208765
Name:GREEN, RICHARD PAUL III (LCDC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:GREEN
Suffix:III
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 BLANCO RD STE 126
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4361
Mailing Address - Country:US
Mailing Address - Phone:210-627-4017
Mailing Address - Fax:210-579-6873
Practice Address - Street 1:7400 BLANCO RD STE 126
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4361
Practice Address - Country:US
Practice Address - Phone:210-627-4017
Practice Address - Fax:210-579-6873
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)