Provider Demographics
NPI:1124732771
Name:GREEN, KRYSTAL CHEYENNE (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:CHEYENNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 LAPIN CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2090
Mailing Address - Country:US
Mailing Address - Phone:512-749-2670
Mailing Address - Fax:
Practice Address - Street 1:7208 LAPIN CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2090
Practice Address - Country:US
Practice Address - Phone:512-749-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
889202OtherNATIONAL BOARD FOR CERTIFIED COUNSELORS