Individual
IVAN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8915 HARRY HINES BLVD, DALLAS, TX 75235-1717
(225) 200-1704
Mailing address
8915 HARRY HINES BLVD, DALLAS, TX 75235-1717
(225) 200-1704
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/22/2015
Last updated
12/02/2022
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