Provider Demographics
NPI:1770107146
Name:CARTER, GALEN HARPER (LSW)
Entity type:Individual
Prefix:
First Name:GALEN
Middle Name:HARPER
Last Name:CARTER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 N ASHLAND BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-6705
Mailing Address - Country:US
Mailing Address - Phone:616-581-5669
Mailing Address - Fax:
Practice Address - Street 1:6830 N ASHLAND BLVD APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-6705
Practice Address - Country:US
Practice Address - Phone:616-581-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1032141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical