Provider Information for 1700409026
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Mr. EARL MARK GREEN M.A. LPC, NCC
Sex: Male
NPI: 1700409026
Last Updated: 2020-05-20
Certification Date: 2020-05-20
Certification Date: 2020-05-20
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1700409026 | ||||||||
| Enumeration Date | 2020-05-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4621 COUNTRY CREEK DR APT 1044 DALLAS, TX 75236-1220 United States Phone: 214-636-8956 | Fax: | ||||||||
| Primary Practice Address | 4621 COUNTRY CREEK DR APT 1044 DALLAS, TX 75236-1220 United States Phone: 214-636-8956 | Fax: | ||||||||
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