Healthcare Provider Details

I. General information

NPI: 1851012181
Provider Name (Legal Business Name): CAROL DAIGLE PTACEK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 MO'S WAY #2470
MCCALL ID
83638-2470
US

IV. Provider business mailing address

PO BOX 2470
MCCALL ID
83638-2470
US

V. Phone/Fax

Practice location:
  • Phone: 520-780-6231
  • Fax:
Mailing address:
  • Phone: 520-780-6231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC3513
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-21854
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5860
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: