MEDICARE: CARPENTER LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174222145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARPENTER LCSW PLLC

Provider Business Mailing Address
First Line	:	4101 SE 85TH ST STE 6
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6325
Country	:	US
Telephone Number	:	405-323-7608
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 SE 85TH ST STE 6
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6325
Country	:	US
Telephone Number	:	405-323-7608
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CRAIG A CARPENTER
Credential	:	LCSW
Telephone Number	:	405-323-7608

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	02/28/2023

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