Healthcare Provider Details

I. General information

NPI: 1225485048
Provider Name (Legal Business Name): MR. KOLBY CARRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2016
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 E PARK AVE
TALLAHASSEE FL
32301-2653
US

IV. Provider business mailing address

2343 CRAWFORDVILLE HWY STE 107
CRAWFORDVILLE FL
32327-1172
US

V. Phone/Fax

Practice location:
  • Phone: 850-920-3522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: