Provider Demographics
NPI:1093171258
Name:CARPENTER, CHASE WILLIAM
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:WILLIAM
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 WILLOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-7047
Mailing Address - Country:US
Mailing Address - Phone:405-620-2747
Mailing Address - Fax:
Practice Address - Street 1:6501 BROADWAY EXT STE 180
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8246
Practice Address - Country:US
Practice Address - Phone:405-607-4041
Practice Address - Fax:405-463-0090
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker