Provider Demographics
NPI:1023010972
Name:CARPENTER, BRIAN D (PHD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 N JACKSON RD
Mailing Address - Street 2:PSYCHOLOGICAL SERVICES CENTER
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2153
Mailing Address - Country:US
Mailing Address - Phone:314-935-8212
Mailing Address - Fax:
Practice Address - Street 1:7 N JACKSON RD
Practice Address - Street 2:PSYCHOLOGICAL SERVICES CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2153
Practice Address - Country:US
Practice Address - Phone:314-935-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000071200Medicare ID - Type Unspecified