Provider Demographics
NPI:1508117169
Name:CARTER, SHANDRA L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CALO LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-9208
Mailing Address - Country:US
Mailing Address - Phone:877-879-2256
Mailing Address - Fax:
Practice Address - Street 1:130 CALO LN
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-9208
Practice Address - Country:US
Practice Address - Phone:877-879-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120312411041C0700X
WALW602436031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical