Provider Demographics
NPI:1861767956
Name:GREEN, SHAMEITRA N (MA, LMFT, LCPI)
Entity type:Individual
Prefix:
First Name:SHAMEITRA
Middle Name:N
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LMFT, LCPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12234 SHADOW CREEK PKWY
Mailing Address - Street 2:STE. 1108
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7330
Mailing Address - Country:US
Mailing Address - Phone:281-846-5393
Mailing Address - Fax:
Practice Address - Street 1:12234 SHADOW CREEK PKWY
Practice Address - Street 2:STE. 1108
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7330
Practice Address - Country:US
Practice Address - Phone:281-846-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67376101YP2500X
TX201441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional