Provider Demographics
NPI:1306364153
Name:CARPENTER, TONYA M
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:M
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CONRAD DUPUYER RD
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-9326
Mailing Address - Country:US
Mailing Address - Phone:406-949-1167
Mailing Address - Fax:406-278-0330
Practice Address - Street 1:600 S MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-2532
Practice Address - Country:US
Practice Address - Phone:406-278-0440
Practice Address - Fax:406-278-0330
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MT426451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42645OtherLCSW LICENSE
MT633437Medicaid
MT35105OtherLAC