Provider Demographics
NPI:1811972201
Name:GREEN, CYNTHIA W (MA, LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:W
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 MEADOW PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2473
Mailing Address - Country:US
Mailing Address - Phone:713-541-2428
Mailing Address - Fax:281-207-1061
Practice Address - Street 1:19855 SOUTHWEST FWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6535
Practice Address - Country:US
Practice Address - Phone:281-494-2008
Practice Address - Fax:281-207-1061
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0049774Medicare ID - Type Unspecified