Provider Demographics
NPI:1154111524
Name:GREEN, NICOLE TECERIA (MS LPC-A)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:TECERIA
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E DEBBIE LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2924
Mailing Address - Country:US
Mailing Address - Phone:915-245-4963
Mailing Address - Fax:
Practice Address - Street 1:201 E DEBBIE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2924
Practice Address - Country:US
Practice Address - Phone:972-333-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251B00000X
TX94967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management