Katie Lynn Green

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113340 Issued in TX

Practice address

3972 Chapel Woods Blvd
Tyler, TX 75707-5474

Phone

(903) 315-0073

NPI assigned

Nov 1, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788566400000",
    "number": "1053076497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3972 CHAPEL WOODS BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757075474",
            "telephone_number": "903-315-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3972 CHAPEL WOODS BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757075474",
            "telephone_number": "903-315-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KATIE",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-01",
        "last_updated": "2026-09-05",
        "certification_date": "2026-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "113340",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "113340",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "012345",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://account.simplepractice.com/saml/auth?SAMLRequest=fVJNj9MwFPwrufnkJk3S3a3VVCqtEJUWiNrAgQvyOq%2BspcQ2fs9s%2Bfc4%2FViCtPRkyW9mPDN%2BC5R958Qq0LPZwc8ASMkKETxpa9bWYOjB78H%2F0gq%2B7B4r9kzkUKQpggoeJqh714HzUlFETJTt0xDZmA66qYyyLNlEUW3koPiXL5WywdBbAiPqdlOx73dlLvN7KHhWtiUvi2zG5SEv%2BDyfPzzl8DDLVRGhiAG2Bkkaqlie5Xc8m%2FNs1kzvxbQQ5fQbS2pvySrbvdOm1eZHxYI3wkrUKIzsAQUpsV99fBT5JBNPZxCKD01T8%2FrzvmHJ1xjtFCMCWHLsO4NisHtbSV4LHVPcbY67WGXLxYAWp3h%2B%2BW9dXDq3SMfzxfk%2FP0W97aa2nVa%2Fk1XX2Ze1B0lQMfIBWPLe%2Bl7SbQfDjW754QQV5KVBDYZYen3ksi%2FQnrYnLgvBkZK17Z30GoeW4Bh9XhOMUesudrKDw%2FJmbUqoARev63i8WN8OHwgqPtkMdpz1dIn%2Fpvh59h%2Bjr9Px7i%2F%2FAA%3D%3D&RelayState=%2Fcalendar%2Fappointments",
            "affiliation": "N",
            "address_1": "7925 S Broadway Ave Ste 440",
            "city": "Tyler",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757035297",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cossette Alina Green, DO
• Darrelland Green, LPC-A
• Jacqueline Green
• Jessica L. Green, CRNA
• Karen A Green, PHARMACIST
• Kelli M Green
• Kelsey Green
• Kevin Dwight Green, M.D.
• Kimberly Ruth Green, RNAS-C
• Lisa Green

• Clinical Social Worker in Tyler, TX
• Providers in Tyler, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.