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NPI Code Detail

MEDICARE: DR. CAROLYN H. GREENLEAF PH.D., LCSW

MEDICARE: DR. CAROLYN H. GREENLEAF PH.D., LCSW
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
1101YM0800XMental Health Counselor11120TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100S86VOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1295807758
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLYN H. GREENLEAF PH.D., LCSW
Provider Business Mailing Address
First Line : 3740 NORTH JOSEY LANE
Second Line : #246
City : CAROOLLTON
State : TX
Zip : 75007
Country : US
Telephone Number : 972-492-0755
Fax Number : 972-492-1398
Provider Business Practice Location Address
First Line : 3740 N JOSEY LN
Second Line : #246
City : CARROLLTON
State : TX
Zip : 75007-2474
Country : US
Telephone Number : 972-492-0755
Fax Number : 972-492-1398
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 07/08/2007

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