Provider Demographics
NPI:1063687192
Name:GREENE, PAM R (MA, LPCS)
Entity type:Individual
Prefix:MRS
First Name:PAM
Middle Name:R
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA, LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 SAN JACINTO BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201
Mailing Address - Country:US
Mailing Address - Phone:214-969-2456
Mailing Address - Fax:214-969-2465
Practice Address - Street 1:1707 SAN JACINTO BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201
Practice Address - Country:US
Practice Address - Phone:214-969-2456
Practice Address - Fax:214-969-2465
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL.P.C.#13626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional