Provider Demographics
NPI:1023703626
Name:GREEN, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
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 1:17571 W LAKE HOUSTON PKWY APT 3101
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5177
Mailing Address - Country:US
Mailing Address - Phone:512-230-3479
Mailing Address - Fax:
Practice Address - Street 1:9701 N SAM HOUSTON PKWY E STE 120
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4693
Practice Address - Country:US
Practice Address - Phone:832-639-4066
Practice Address - Fax:832-408-7441
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker