Provider Demographics
NPI:1790992162
Name:CARVER, HARRY GLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:GLEN
Last Name:CARVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27935 E 113TH ST
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-3805
Mailing Address - Country:US
Mailing Address - Phone:804-615-9650
Mailing Address - Fax:
Practice Address - Street 1:2141 W CONCORD CIR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1459
Practice Address - Country:US
Practice Address - Phone:918-288-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2537101YP2500X
LA450106H00000X
OK11498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist