Provider Demographics
NPI:1083792451
Name:CARPENTER, JOHN STEPHEN (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEPHEN
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14517
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65814-0517
Mailing Address - Country:US
Mailing Address - Phone:417-425-0065
Mailing Address - Fax:417-335-8566
Practice Address - Street 1:590 W PACIFIC ST
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2742
Practice Address - Country:US
Practice Address - Phone:417-335-2080
Practice Address - Fax:417-336-3583
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0009391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496920307Medicaid
MO496920331Medicaid
MO496920331Medicaid