Healthcare Provider Details

I. General information

NPI: 1295952240
Provider Name (Legal Business Name): CAROLYN JEAN GREENWOOD LMFT, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 LINWOOD BLVD
OKLAHOMA CITY OK
73106-5022
US

IV. Provider business mailing address

1418 LINWOOD BLVD
OKLAHOMA CITY OK
73106-5022
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-0295
  • Fax: 405-601-0316
Mailing address:
  • Phone: 405-601-0295
  • Fax: 405-601-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number516
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number835
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: