Provider Demographics
NPI:1902046386
Name:CARPENTER, JESSE RALPH (LPC-MHSP)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:RALPH
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 SINAI DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TN
Mailing Address - Zip Code:38049-7627
Mailing Address - Country:US
Mailing Address - Phone:901-496-7476
Mailing Address - Fax:901-416-9939
Practice Address - Street 1:2855 SINAI DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TN
Practice Address - Zip Code:38049-7627
Practice Address - Country:US
Practice Address - Phone:901-496-7476
Practice Address - Fax:901-416-9939
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional