Healthcare Provider Details

I. General information

NPI: 1154225720
Provider Name (Legal Business Name): ERIK RICH CARROLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 COUNTY ROAD 3610
SAINT JAMES MO
65559-9151
US

IV. Provider business mailing address

21021 LACOMBE RD
WAYNESVILLE MO
65583-3107
US

V. Phone/Fax

Practice location:
  • Phone: 844-424-3577
  • Fax:
Mailing address:
  • Phone: 904-710-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2026042701
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: