Provider Demographics
NPI:1629706684
Name:CARPENTER, JULIANNA FAITH (LSSP)
Entity Type:Individual
Prefix:DR
First Name:JULIANNA
Middle Name:FAITH
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 US HIGHWAY 62 207
Mailing Address - Street 2:
Mailing Address - City:RALLS
Mailing Address - State:TX
Mailing Address - Zip Code:79357-5405
Mailing Address - Country:US
Mailing Address - Phone:832-279-6553
Mailing Address - Fax:
Practice Address - Street 1:1003 3RD ST.
Practice Address - Street 2:
Practice Address - City:LORENZO
Practice Address - State:TX
Practice Address - Zip Code:79343
Practice Address - Country:US
Practice Address - Phone:806-634-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71144103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool