Provider Demographics
NPI:1467003350
Name:GREEN, SHANNA TIPTON (LPC)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:TIPTON
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:MARIE
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1057 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6257
Mailing Address - Country:US
Mailing Address - Phone:806-282-6061
Mailing Address - Fax:
Practice Address - Street 1:1057 ACORN LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6257
Practice Address - Country:US
Practice Address - Phone:806-282-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015265101YP2500X
TX68303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional