Provider Demographics
NPI:1053614164
Name:CARNEY, GLENYSS AMMONS (LCPC)
Entity type:Individual
Prefix:
First Name:GLENYSS
Middle Name:AMMONS
Last Name:CARNEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 ALICE LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-3033
Mailing Address - Country:US
Mailing Address - Phone:406-936-4066
Mailing Address - Fax:
Practice Address - Street 1:725 W ALDER ST
Practice Address - Street 2:SUITE 18
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4036
Practice Address - Country:US
Practice Address - Phone:406-396-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1298-LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional