Provider Demographics
NPI:1669740858
Name:CARPENTER, CORY DEAN (PCSW, CAP)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:DEAN
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1720
Mailing Address - Country:US
Mailing Address - Phone:307-202-1067
Mailing Address - Fax:307-460-7029
Practice Address - Street 1:306 N BENT ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2338
Practice Address - Country:US
Practice Address - Phone:307-202-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY152101YA0400X
WYPCSW-8431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)