Healthcare Provider Details

I. General information

NPI: 1700334513
Provider Name (Legal Business Name): ROBERT CARPENTER LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 RACE ST SUITE 302
CINCINNATI OH
45202-7297
US

IV. Provider business mailing address

1404 RACE ST SUITE 302
CINCINNATI OH
45202-7297
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-1531
  • Fax:
Mailing address:
  • Phone: 513-381-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103321
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: