Healthcare Provider Details

I. General information

NPI: 1083792451
Provider Name (Legal Business Name): JOHN STEPHEN CARPENTER MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PACIFIC ST
BRANSON MO
65616-2742
US

IV. Provider business mailing address

PO BOX 14517
SPRINGFIELD MO
65814-0517
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-2080
  • Fax: 417-336-3583
Mailing address:
  • Phone: 417-425-0065
  • Fax: 417-335-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW000939
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: