Provider Demographics
NPI:1104163211
Name:CARPENTER, BETHANY C
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:C
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 DEBARR RD STE L
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1777
Mailing Address - Country:US
Mailing Address - Phone:907-336-3365
Mailing Address - Fax:
Practice Address - Street 1:6311 DEBARR RD STE L
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1777
Practice Address - Country:US
Practice Address - Phone:907-336-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker