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NPI Code Detail

MEDICARE: SHANDRA L CARTER LCSW

MEDICARE: SHANDRA L CARTER LCSW
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
11041C0700XClinical Social Worker2012031241MO
21041C0700XClinical Social WorkerLW60243603WA

General Provider Information

NPI Number : 1508117169
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANDRA L CARTER LCSW
Provider Business Mailing Address
First Line : 130 CALO LN
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9208
Country : US
Telephone Number : 877-879-2256
Fax Number :
Provider Business Practice Location Address
First Line : 130 CALO LN
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9208
Country : US
Telephone Number : 877-879-2256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2012
Last Update Date : 08/19/2013

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Directions to “ SHANDRA L CARTER LCSW” Practice Location

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