Provider Demographics
NPI:1174068514
Name:CARTER, ROBERT JR (MS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:CARTER
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 LADYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-8274
Mailing Address - Country:US
Mailing Address - Phone:702-596-7805
Mailing Address - Fax:
Practice Address - Street 1:686 LADYWOOD LN
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-8274
Practice Address - Country:US
Practice Address - Phone:702-596-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55164101YS0200X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician