Provider Demographics
NPI:1982069480
Name:CARPENTER HOUSE INC.
Entity Type:Organization
Organization Name:CARPENTER HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LMHC
Authorized Official - Phone:850-897-7810
Mailing Address - Street 1:PO BOX 5383
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-5383
Mailing Address - Country:US
Mailing Address - Phone:850-897-7810
Mailing Address - Fax:850-897-0032
Practice Address - Street 1:4400 E HIGHWAY 20
Practice Address - Street 2:SUITE 306
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8779
Practice Address - Country:US
Practice Address - Phone:850-897-7810
Practice Address - Fax:850-897-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty