Active NPI
Jerry Wayne Green, LPC
- Professional Counselor
- Grand Prairie, TX
National Provider Identifier
1992361497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 14932
- Practice address
- 2463 Waterside Dr
Grand Prairie, TX 75054-6806 - Phone
- (817) 673-2183
- NPI assigned
- May 10, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 14932 | TX | Primary |
Addresses
Primary practice location
2463 Waterside Dr
Grand Prairie, TX 75054-6806
Mailing address
2463 Waterside Dr
Grand Prairie, TX 75054-6806
Phone (817) 673-2183
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14932 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557446400000",
"number": "1992361497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2463 WATERSIDE DR",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750546806",
"telephone_number": "817-673-2183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2463 WATERSIDE DR",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750546806",
"telephone_number": "817-673-2183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JERRY",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-10",
"last_updated": "2019-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "14932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Prairie, TX
- Great Southwest Family Dental Professional Association
- Great Southwest Medical LLC
- Greater Southwest Injury & Rehab Inc.
- Green Oaks Physical Therapy Limited Partnership
- Green Oaks Physical Therapy LP
- Karina L Green, LPC
- Darla Greene, M.S. CCC-SLP
- Greenhouse Treatment Center, LLC
- Greenlight Home Health Care Services Inc.
- Greenwich Healthcare Services Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.