Connie Laverne Green

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

5920 Issued in TX

Practice address

230 S Nolen Dr BLDG 3
Southlake, TX 76092-8078

Phone

(817) 402-8250

NPI assigned

Jun 30, 2023

Last updated

Jun 30, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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• Thrive and Shine ABA Services LLC

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• Reach Inc

  dba Bright Mosaic

  • Behavior Analyst
  • Denton, TX
  • NPI 1235596222
  NPD (past)

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1790462786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 S MOPAC EXPY STE C300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787467077",
            "telephone_number": "512-920-1030",
            "fax_number": "512-256-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S NOLEN DR BLDG 3",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928078",
            "telephone_number": "817-402-8250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "CONNIE",
        "middle_name": "LAVERNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "5920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Night Sleep Company LLC
• Greater Anesthesia Consultants
• Green Birdd Freight LLC
• Green Hills Associates PLLC
• Andrew Green, DPT
• Edward Aric Green
• Sydjea M Green, PHD
• Latasha D Greene
• William Greenlee, DC
• Destinee Nichole Greenwell, LPC, LCDC

• Behavior Analyst in Southlake, TX
• Providers in Southlake, TX by specialty
• Behavior Analyst in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.