Provider Demographics
NPI:1558800136
Name:CARPENTER, CHERLEIGH
Entity Type:Individual
Prefix:
First Name:CHERLEIGH
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERLEIGH
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW/MHP/EDD (05/17)
Mailing Address - Street 1:310 E 38TH ST
Mailing Address - Street 2:SUITE #225
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1300
Mailing Address - Country:US
Mailing Address - Phone:612-821-2300
Mailing Address - Fax:612-827-1215
Practice Address - Street 1:310 E 38TH ST
Practice Address - Street 2:SUITE #225
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1300
Practice Address - Country:US
Practice Address - Phone:612-821-2300
Practice Address - Fax:612-827-1215
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN274271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical