Provider Demographics
NPI:1649494303
Name:CARPENTER, NECOLE MARIE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:NECOLE
Middle Name:MARIE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1021
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74067-1021
Mailing Address - Country:US
Mailing Address - Phone:918-645-0762
Mailing Address - Fax:
Practice Address - Street 1:15 E DEWEY AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4201
Practice Address - Country:US
Practice Address - Phone:918-227-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175L00000X
OK4172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No175L00000XOther Service ProvidersHomeopath