1609010982 NPI number — MRS. TIFFANY KAYE CARPENTER L.C.S.W.

Table of content: MRS. TIFFANY KAYE CARPENTER L.C.S.W. (NPI 1609010982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609010982 NPI number — MRS. TIFFANY KAYE CARPENTER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
TIFFANY
Provider Middle Name:
KAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAROTHERS
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
KAYE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609010982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 RIDGECREST CIR STE A-6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79109-5416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-282-5106
Provider Business Mailing Address Fax Number:
888-393-2231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 W AMARILLO BLVD
Provider Second Line Business Practice Location Address:
BLDG 45
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-9703
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2009

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 , with the licence number:  50518-170774 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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