Healthcare Provider Details

I. General information

NPI: 1326961566
Provider Name (Legal Business Name): LOGAN CARPENTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S PERRY ST
CASTLE ROCK CO
80104-1919
US

IV. Provider business mailing address

3432 GREY CT
CASTLE ROCK CO
80104-7809
US

V. Phone/Fax

Practice location:
  • Phone: 719-309-2684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: