Provider Demographics
NPI:1245496157
Name:CARTER, FREDERICK THACHER (PSYD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:THACHER
Last Name:CARTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63670 OWSLEY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-5177
Mailing Address - Country:US
Mailing Address - Phone:541-962-7491
Mailing Address - Fax:
Practice Address - Street 1:105 FIR ST
Practice Address - Street 2:SUITE 332
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2661
Practice Address - Country:US
Practice Address - Phone:541-910-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1172103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist