Healthcare Provider Details

I. General information

NPI: 1093171258
Provider Name (Legal Business Name): CHASE WILLIAM CARPENTER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S MUSTANG RD STE B
YUKON OK
73099-7314
US

IV. Provider business mailing address

416 S MUSTANG RD STE B
YUKON OK
73099-7314
US

V. Phone/Fax

Practice location:
  • Phone: 405-256-8988
  • Fax:
Mailing address:
  • Phone: 405-256-8988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12085
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: