Provider Demographics
NPI:1174222145
Name:CARPENTER LCSW PLLC
Entity type:Organization
Organization Name:CARPENTER LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-323-7608
Mailing Address - Street 1:4101 SE 85TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6325
Mailing Address - Country:US
Mailing Address - Phone:405-323-7608
Mailing Address - Fax:
Practice Address - Street 1:4101 SE 85TH ST STE 6
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-6325
Practice Address - Country:US
Practice Address - Phone:405-323-7608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty