MEDICARE: MR. SHAWN PATRICK CARPENTER ASC, ACMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	13281900-3503	UT
2	101YP2500X	Professional Counselor	RC00049222	WA
3	373H00000X	Day Training/Habilitation Specialist
4	101Y00000X	Counselor	13281900-6009	UT
5	225800000X	Recreation Therapist		UT

General Provider Information

NPI Number	:	1033386297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN PATRICK CARPENTER ASC, ACMHC

Provider Business Mailing Address
First Line	:	1201 E 4500 S
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 E 4500 S
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4124
Country	:	US
Telephone Number	:	801-261-3664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	11/03/2025

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