Healthcare Provider Details

I. General information

NPI: 1073593414
Provider Name (Legal Business Name): NANCY A CARPER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N MAIN ST
PRINCETON IL
61356-9771
US

IV. Provider business mailing address

PO BOX 361
CLINTON IA
52733-0361
US

V. Phone/Fax

Practice location:
  • Phone: 815-872-2100
  • Fax: 363-242-3128
Mailing address:
  • Phone: 563-242-5316
  • Fax: 563-242-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: