Healthcare Provider Details

I. General information

NPI: 1457444523
Provider Name (Legal Business Name): DOUG CARPENTER PSYD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 UNIVERSITY DR STE 140
AUBURN HILLS MI
48326-4606
US

IV. Provider business mailing address

3121 UNIVERSITY DR STE 140
AUBURN HILLS MI
48326-4606
US

V. Phone/Fax

Practice location:
  • Phone: 248-923-2099
  • Fax: 248-923-2096
Mailing address:
  • Phone: 248-923-2099
  • Fax: 248-923-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: