Individual
LAKEISHA DEEANN MARSH GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5200 HARRY HINES BLVD, DALLAS, TX 75235-7709
(469) 419-9606
(214) 648-9627
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 590-8761
(214) 590-1491
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
N6473
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215836201
—
TX
01
—
8CL779
BCBS
TX
01
—
P00962622
RAILROAD MEDICARE
TX
Enumeration date
08/06/2008
Last updated
08/12/2019
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