MEDICARE: MARY ALICE MARTIN CARPENTER LMFT-A

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	176B00000X	Midwife	99370	TX
2	374J00000X	Doula
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1457730285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ALICE MARTIN CARPENTER LMFT-A

Provider Business Mailing Address
First Line	:	1318 MARSHALL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-4214
Country	:	US
Telephone Number	:	832-433-5241
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 MERCER ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6525
Country	:	US
Telephone Number	:	713-561-3884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	05/09/2023

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