Healthcare Provider Details

I. General information

NPI: 1649494303
Provider Name (Legal Business Name): NECOLE MARIE CARPENTER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E DEWEY AVE
SAPULPA OK
74066-4201
US

IV. Provider business mailing address

PO BOX 1021
SAPULPA OK
74067-1021
US

V. Phone/Fax

Practice location:
  • Phone: 918-227-2016
  • Fax:
Mailing address:
  • Phone: 918-645-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4172
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: