Provider Demographics
NPI:1841340197
Name:GREEN, JOHN B (LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:GREEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2537
Mailing Address - Country:US
Mailing Address - Phone:469-644-9537
Mailing Address - Fax:972-264-6758
Practice Address - Street 1:900 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2537
Practice Address - Country:US
Practice Address - Phone:469-644-9537
Practice Address - Fax:972-264-6758
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14207101Y00000X
TX32696104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32696OtherSOCIAL WORKER
TX11624270OtherCAQH
TX14207OtherLPC