Healthcare Provider Details

I. General information

NPI: 1952351454
Provider Name (Legal Business Name): CAROL A. CARVER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 NW KINGS BLVD SUITE 102
CORVALLIS OR
97330-3978
US

IV. Provider business mailing address

2380 NW KINGS BLVD SUITE 102
CORVALLIS OR
97330-3978
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-2066
  • Fax: 541-757-9651
Mailing address:
  • Phone: 541-757-2066
  • Fax: 541-757-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number477
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number477
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: