Healthcare Provider Details

I. General information

NPI: 1831209956
Provider Name (Legal Business Name): DIANNE LOU CARPENTER LMFT, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 W SPRUCE ST
OLATHE KS
66061-3123
US

IV. Provider business mailing address

6000 LAMAR AVE STE 130
MISSION KS
66202-3234
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-2100
  • Fax:
Mailing address:
  • Phone: 913-831-2550
  • Fax: 913-826-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number74300
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number32
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: