Provider Demographics
NPI:1669049797
Name:GREENE, COURTLYN TAYLOR (MS, LPC ASSOCIATE)
Entity type:Individual
Prefix:MS
First Name:COURTLYN
Middle Name:TAYLOR
Last Name:GREENE
Suffix:
Gender:F
Credentials:MS, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 LAKE CAROLYN PKWY APT 1050
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4854
Mailing Address - Country:US
Mailing Address - Phone:409-617-8726
Mailing Address - Fax:
Practice Address - Street 1:3020 BROADMOOR LN STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2705
Practice Address - Country:US
Practice Address - Phone:409-617-8726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health