1306364153 NPI number — MS. TONYA M CARPENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306364153 NPI number — MS. TONYA M CARPENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
TONYA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1306364153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3002 MAMMOTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTTE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59701-8008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-560-7724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3002 MAMMOTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTTE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59701-8008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-560-7724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2017

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: 101YA0400X , with the licence number:  BBH-LAC-LIC-35105 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: BBH-LCSW-LIC-42645 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35105 . This is a "LAC" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 42645 . This is a "LCSW LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 633437 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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