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General NPI Number Information
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NPI Number | 1033386297
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Entity Type | Individual
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Provider Name | SHAWN PATRICK CARPENTER ASC, ACMHC
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Gender | Male
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1201 E 4500 S
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City | MILLCREEK
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State | UT
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Zip | 84117-4124
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Country | US
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Telephone | 801-261-3664
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 E 4500 S
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City | MILLCREEK
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State | UT
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Zip | 84117-4124
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 13281900-3503
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | RC00049222
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 13281900-6009
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License Number State | UT
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Taxonomy #5
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State | UT
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