Provider Demographics
NPI:1780936187
Name:GREEN, ALEXANDRA (MS, LCPC, LPC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1309
Mailing Address - Country:US
Mailing Address - Phone:713-203-9061
Mailing Address - Fax:
Practice Address - Street 1:8203 RENMARK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3620
Practice Address - Country:US
Practice Address - Phone:713-203-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008519101YP2500X
TX76600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional