Provider Demographics
NPI:1952429698
Name:CARPENTER, MOLLY (MA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MARTYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:6175 EAGLES NEST DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1506
Mailing Address - Country:US
Mailing Address - Phone:720-217-8869
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 50 EAST & EVANS BLVD
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81215
Practice Address - Country:US
Practice Address - Phone:719-269-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional