Provider Demographics
NPI:1013469808
Name:CARPENTER, MELINDA (COUI)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:COUI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DESERT SAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-1038
Mailing Address - Country:US
Mailing Address - Phone:208-587-3398
Mailing Address - Fax:208-587-3324
Practice Address - Street 1:120 DESERT SAGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-1038
Practice Address - Country:US
Practice Address - Phone:208-587-3988
Practice Address - Fax:208-587-3324
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health