Individual
MARY J CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS ED LP
Contact information
Practice address
624 S 13TH ST, RANGE MENTAL HEALTH CENTER INC, VIRGINIA, MN 55792
(218) 749-2881
(218) 749-3806
Mailing address
PO BOX 1188, RANGE MENTAL HEALTH CENTER INC, VIRGINIA, MN 55792-1188
(218) 749-2881
(218) 749-3806
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1593
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271753100
—
MN
Enumeration date
09/26/2006
Last updated
12/04/2014
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