Provider Demographics
NPI:1437905908
Name:CARPENTER, STACY (MS, LMT, BCCS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MS, LMT, BCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 SLIGO RD
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7605
Mailing Address - Country:US
Mailing Address - Phone:318-464-5148
Mailing Address - Fax:
Practice Address - Street 1:1534 ELIZABETH AVE STE 401
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4531
Practice Address - Country:US
Practice Address - Phone:318-464-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
LA10024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other