1568567352 NPI number — MRS. PAULA ANGLIN CARPENTER LMSW

Table of content: MRS. PAULA ANGLIN CARPENTER LMSW (NPI 1568567352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568567352 NPI number — MRS. PAULA ANGLIN CARPENTER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
PAULA
Provider Middle Name:
ANGLIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568567352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
342A COUNTY ROAD 395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALTILLO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38866-9105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-869-2923
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2434 S EASON BLVD
Provider Second Line Business Practice Location Address:
REGION III MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38804-6942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-844-1717
Provider Business Practice Location Address Fax Number:
662-680-6416
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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