Provider Demographics
NPI:1457444523
Name:CARPENTER, DOUG (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W UNIVERSITY DR STE 308
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1876
Mailing Address - Country:US
Mailing Address - Phone:248-923-2099
Mailing Address - Fax:248-923-2096
Practice Address - Street 1:1000 W UNIVERSITY DR STE 308
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1876
Practice Address - Country:US
Practice Address - Phone:248-923-2099
Practice Address - Fax:248-923-2096
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7581Medicare UPIN
MIN101900006Medicare UPIN