Healthcare Provider Details

I. General information

NPI: 1790640225
Provider Name (Legal Business Name): CARROLL PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MAIN AVE STE 7
BROOKINGS SD
57006-2010
US

IV. Provider business mailing address

510 MAIN AVE STE 7
BROOKINGS SD
57006-2010
US

V. Phone/Fax

Practice location:
  • Phone: 605-865-4105
  • Fax: 605-443-1320
Mailing address:
  • Phone: 605-865-4105
  • Fax: 605-443-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELSEY CARROLL
Title or Position: PROVIDER/OWNER
Credential: LCSW- PIP
Phone: 605-865-4105