Provider Demographics
NPI:1255821518
Name:GREEN, DEEANNA (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:DEEANNA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7470 GOLDEN POND PL STE 300
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-2100
Mailing Address - Country:US
Mailing Address - Phone:806-356-9047
Mailing Address - Fax:806-356-9046
Practice Address - Street 1:7470 GOLDEN POND PL STE 300
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-2100
Practice Address - Country:US
Practice Address - Phone:806-356-9047
Practice Address - Fax:806-356-9046
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74674101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional