Provider Demographics
NPI:1215249099
Name:CARTER, JAMES WESLEY (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WESLEY
Last Name:CARTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1108
Mailing Address - Country:US
Mailing Address - Phone:580-761-2269
Mailing Address - Fax:
Practice Address - Street 1:2203 N ASH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1108
Practice Address - Country:US
Practice Address - Phone:580-762-8341
Practice Address - Fax:580-762-9967
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional