Provider Demographics
NPI:1952610206
Name:CARPENTER, JAMES WOODWARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WOODWARD
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WHITE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-8315
Mailing Address - Country:US
Mailing Address - Phone:580-765-2501
Mailing Address - Fax:580-765-3648
Practice Address - Street 1:2525 NW EXPRESSWAY STE 312
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7200
Practice Address - Country:US
Practice Address - Phone:405-840-9999
Practice Address - Fax:405-840-9998
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1302012101YP2500X
AR15-04P103G00000X, 103TC0700X
MO2015016464103G00000X, 103TC0700X, 103TH0100X
OK1257103G00000X, 103TH0100X
KS2416103TC0700X, 103TC0700X
TX32763103TS0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1952610206Medicaid
AR1952610206Medicare UPIN
AR1952610206Medicare Oscar/Certification
AR1952610206Medicare PIN
AR1952610206Medicaid