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Individual

CONNIE LAVERNE GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
230 S NOLEN DR BLDG 3, SOUTHLAKE, TX 76092-8078
(817) 402-8250
Mailing address
1601 S MOPAC EXPY STE C300, AUSTIN, TX 78746-7077
(512) 920-1030
(512) 256-1983

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
5920
TX

Other

Enumeration date
06/30/2023
Last updated
06/30/2023
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