Provider Demographics
NPI:1700945748
Name:CARTER, BRENT NELSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:NELSON
Last Name:CARTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 STANDIFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0726
Mailing Address - Country:US
Mailing Address - Phone:209-557-1177
Mailing Address - Fax:209-557-1083
Practice Address - Street 1:1320 STANDIFORD AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0726
Practice Address - Country:US
Practice Address - Phone:209-557-1177
Practice Address - Fax:209-557-1083
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical