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General NPI Number Information
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NPI Number | 1275279259
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Entity Type | Individual
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Provider Name | BRUCE EDWIN CARPENTER L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 6607 SABROSA CT E
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City | FT WORTH
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State | TX
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Zip | 76133-5251
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Country | US
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Telephone | 903-654-0784
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331535
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City | FT WORTH
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State | TX
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Zip | 76163-1535
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Country | US
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Telephone | 903-654-0784
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73166
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License Number State | TX
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