Healthcare Provider Details

I. General information

NPI: 1255591400
Provider Name (Legal Business Name): VIP MENTAL HEALTH AND LIFE COACHING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 02/21/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E WILLIAM ST
CARSON CITY NV
89701-4056
US

IV. Provider business mailing address

1894 E WILLIAM ST STE 4-496
CARSON CITY NV
89701-3224
US

V. Phone/Fax

Practice location:
  • Phone: 602-909-1710
  • Fax:
Mailing address:
  • Phone: 602-909-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KAREN TORRY GREENE
Title or Position: OWNER
Credential: LCSW
Phone: 602-909-1710