Provider Demographics
NPI:1154045565
Name:CARPENTER, JENNIFER THERESE (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THERESE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 AURORA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2833
Mailing Address - Country:US
Mailing Address - Phone:515-883-1776
Mailing Address - Fax:515-883-2161
Practice Address - Street 1:6000 AURORA AVE STE B
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-2833
Practice Address - Country:US
Practice Address - Phone:515-883-1776
Practice Address - Fax:515-883-2171
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health