MEDICARE: MRS. CAROLYN JEAN GREENWOOD LMFT, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	516	OK
2	106H00000X	Marriage & Family Therapist	835	OK

General Provider Information

NPI Number	:	1295952240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN JEAN GREENWOOD LMFT, LADC

Provider Business Mailing Address
First Line	:	1418 LINWOOD BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5022
Country	:	US
Telephone Number	:	405-601-0295
Fax Number	:	405-601-0316

Provider Business Practice Location Address
First Line	:	1418 LINWOOD BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5022
Country	:	US
Telephone Number	:	405-601-0295
Fax Number	:	405-601-0316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/01/2013

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