Provider Demographics
NPI:1053884676
Name:GREEN, MONTREECE NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:MONTREECE
Middle Name:NICOLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200764
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-0764
Mailing Address - Country:US
Mailing Address - Phone:210-860-0637
Mailing Address - Fax:
Practice Address - Street 1:558 COUNTY ROAD 356
Practice Address - Street 2:
Practice Address - City:ADKINS
Practice Address - State:TX
Practice Address - Zip Code:78101-2407
Practice Address - Country:US
Practice Address - Phone:210-860-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical