Provider Demographics
NPI:1265534101
Name:CARPENTER, CHARLES SHELDON (LMLP, LCP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:SHELDON
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:LMLP, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10422 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-8103
Mailing Address - Country:US
Mailing Address - Phone:620-672-3824
Mailing Address - Fax:620-672-1083
Practice Address - Street 1:610 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-2708
Practice Address - Country:US
Practice Address - Phone:620-723-2272
Practice Address - Fax:620-723-3450
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0254103T00000X
KS041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist