1255927406 NPI number — MISS KASEY RAE CARPENTER LMFT

Table of content: DONNA S REYES (NPI 1033936216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255927406 NPI number — MISS KASEY RAE CARPENTER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
KASEY
Provider Middle Name:
RAE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1255927406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 W GILA SPRINGS PL STE 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85226-3539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-282-8778
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5635 N SCOTTSDALE RD SUITE #170
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-805-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2020

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: 106H00000X , with the licence number:  LAMFT-10704 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NONE . This is a "NONE" identifier . This identifiers is of the category "OTHER".