Provider Demographics
NPI:1043083801
Name:CARPENTER, SHELLI RAE (LPCA)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:RAE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:RAE
Other - Last Name:RIDENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 BRECKENRIDGE LN STE 114
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3868
Mailing Address - Country:US
Mailing Address - Phone:502-653-7211
Mailing Address - Fax:502-416-0723
Practice Address - Street 1:214 BRECKENRIDGE LN STE 114
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3868
Practice Address - Country:US
Practice Address - Phone:502-653-7211
Practice Address - Fax:502-416-0723
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272705101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health