Provider Demographics
NPI:1275845166
Name:CARPENTER, ANNE (PHD, PLC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PHD, PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8628
Mailing Address - Country:US
Mailing Address - Phone:269-408-6119
Mailing Address - Fax:269-429-3323
Practice Address - Street 1:3408 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8628
Practice Address - Country:US
Practice Address - Phone:269-429-3324
Practice Address - Fax:269-429-3323
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013553103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical