Provider Demographics
NPI:1447318282
Name:GREEN, CARRY L (MA LMHP LPC)
Entity type:Individual
Prefix:MRS
First Name:CARRY
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA LMHP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2020
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:602-230-5105
Practice Address - Street 1:9014 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-8304
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-230-5105
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2389101YM0800X
NE1316101YP2500X
AZLPC-17306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84002OtherBLUE CROSS BLUE SHIELD
NE234934OtherMIDLANDS CHOICE