Provider Demographics
NPI:1861144230
Name:CARPENTER, KRYSTLE MARIE (LMHC-LP)
Entity type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:MARIE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W 164TH ST APT 43C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-0451
Mailing Address - Country:US
Mailing Address - Phone:815-715-3611
Mailing Address - Fax:
Practice Address - Street 1:625 W 164TH ST APT 43C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-0451
Practice Address - Country:US
Practice Address - Phone:815-715-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP112367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health