Provider Demographics
NPI:1760419535
Name:KANE, CARRIE JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JEAN
Last Name:KANE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 S LAGUNA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-4945
Mailing Address - Country:US
Mailing Address - Phone:928-669-6906
Mailing Address - Fax:928-669-6909
Practice Address - Street 1:1017 S LAGUNA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-4945
Practice Address - Country:US
Practice Address - Phone:928-669-6906
Practice Address - Fax:928-669-6909
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ797459Medicaid