Provider Demographics
NPI:1033083159
Name:CARPENTER, CHLOE EYLSE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:EYLSE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 W 14TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6917
Mailing Address - Country:US
Mailing Address - Phone:480-863-0763
Mailing Address - Fax:480-898-7491
Practice Address - Street 1:2005 W 14TH ST STE 121
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6917
Practice Address - Country:US
Practice Address - Phone:480-863-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician