Healthcare Provider Details

I. General information

NPI: 1457730285
Provider Name (Legal Business Name): MARY ALICE MARTIN CARPENTER LMFT-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ALICE MARTIN

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 MERCER ST STE 100
HOUSTON TX
77027-6525
US

IV. Provider business mailing address

1318 MARSHALL ST
HOUSTON TX
77006-4214
US

V. Phone/Fax

Practice location:
  • Phone: 713-561-3884
  • Fax:
Mailing address:
  • Phone: 832-433-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99370
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: