Provider Demographics
NPI:1417200544
Name:CARPENTER, CORVETTA (BHRS)
Entity type:Individual
Prefix:
First Name:CORVETTA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:LANGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73050-0412
Mailing Address - Country:US
Mailing Address - Phone:405-612-6740
Mailing Address - Fax:
Practice Address - Street 1:2133 HWY 33
Practice Address - Street 2:LANGSTON COMMONS APT 15H
Practice Address - City:LANGSTON
Practice Address - State:OK
Practice Address - Zip Code:73050-0400
Practice Address - Country:US
Practice Address - Phone:405-612-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor