| Doctor Name: | MARY J CARPENTER |
| NPI Number: | 1265533640 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS ED LP |
| License Number: | LP1593 |
| Business Practice Address: | 624 S 13th St Range Mental Health Center Inc Virginia, MN - 55792 |
| Business Phone Number: | 2187492881 |
| Business Fax Number: | 2187493806 |
| Mailing Address: | Po Box 1188, Range Mental Health Center Inc VIRGINIA |
| State: | MN |
| Postal Code: | 557921188 |
| Phone Number: | 2187492881 |
| Fax Number: | 2187493806 |
| NPI Enumeration Date: | 09/26/2006 |
| NPI Last Update Date: | 12/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP1593 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |