NPIMap

Organization Active NPI

Liberty Lake Couple and Family Therapy, LLC

Doing business as Liberty Lake Couple and Family Therapy

  • Marriage & Family Therapist
  • Liberty Lake, WA
National Provider Identifier
1679165773
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
LIBERTY LAKE COUPLE AND FAMILY THERAPY, LLC
Doing business as
Liberty Lake Couple and Family Therapy
Liberty Lake Therapy
Practice address
1334 N Whitman LN Ste 140
Liberty Lake, WA 99019-6034
Phone
(509) 443-5015
Fax
(509) 443-5373
NPI assigned
Feb 9, 2021
Last updated
Oct 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Carmen MH Green, LMFT, LMHCNPI 1962094599
Title
Therapist
Phone
(509) 443-5015

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

1334 N Whitman LN Ste 140
Liberty Lake, WA 99019-6034

Mailing address

18621 E Alki Ave
Spokane Valley, WA 99016-9505
Phone (509) 443-5015

Other practice location 1

18621 E Alki Ave
Spokane Valley, WA 99016-9505
Phone (509) 443-5015

Other names 2

  • Liberty Lake Couple and Family Therapy Doing business as
  • Liberty Lake Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260128003749 WA Part B Supplier - Clinic/Group Practice 7214415504 Receives reassigned benefits from 1 practitioner
Practice locations: Spokane Valley, WA

National Provider Directory

National Provider Directory

Locations

1334 N Whitman Ln
Ste 140
Liberty Lake, WA 99019
Phone (509) 443-5015

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760918400000",
    "number": "1679165773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18621 E ALKI AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "990169505",
            "telephone_number": "509-443-5015",
            "fax_number": "509-443-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 N WHITMAN LN STE 140",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990196034",
            "telephone_number": "509-443-5015",
            "fax_number": "509-443-5373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18621 E Alki Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane Valley",
            "state": "WA",
            "postal_code": "990169505",
            "country_code": "US",
            "telephone_number": "509-443-5015",
            "fax_number": "509-443-5373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIBERTY LAKE COUPLE AND FAMILY THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "MH",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "509-443-5015",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMFT, LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Lake Couple and Family Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Liberty Lake Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.