Provider Demographics
NPI:1679165773
Name:LIBERTY LAKE COUPLE AND FAMILY THERAPY, LLC
Entity type:Organization
Organization Name:LIBERTY LAKE COUPLE AND FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MH
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LMHC
Authorized Official - Phone:253-230-3613
Mailing Address - Street 1:1334 N WHITMAN LN STE 140
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6034
Mailing Address - Country:US
Mailing Address - Phone:253-230-3613
Mailing Address - Fax:
Practice Address - Street 1:1334 N WHITMAN LN STE 140
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6034
Practice Address - Country:US
Practice Address - Phone:253-230-3613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty