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General NPI Number Information
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NPI Number | 1679165773
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Entity Type | Organization
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Legal Business Name | LIBERTY LAKE COUPLE AND FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1334 N WHITMAN LN STE 140
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-6034
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Country | US
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Telephone | 509-443-5015
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Fax | 509-443-5373
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Provider Business Mailing Address
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Address Line | 18621 E ALKI AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99016-9505
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Country | US
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Telephone | 509-443-5015
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Fax | 509-443-5373
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. CARMEN MH GREEN
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Credential | LMFT, LMHC
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Telephone | 509-443-5015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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