| Doctor Name: | MS. TYRA NICOLE GREEN |
| NPI Number: | 1710293303 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LC2671 |
| Business Practice Address: | 5502 Windsor Mill Rd Gwynn Oak, MD - 212075924 |
| Business Phone Number: | 2402742951 |
| Business Fax Number: | 3018569589 |
| Mailing Address: | 5502 Windsor Mill Rd, GWYNN OAK |
| State: | MD |
| Postal Code: | 212075924 |
| Phone Number: | 2402742951 |
| Fax Number: | 3018569589 |
| NPI Enumeration Date: | 08/20/2010 |
| NPI Last Update Date: | 08/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LC2671 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |