Healthcare Provider Details

I. General information

NPI: 1144133083
Provider Name (Legal Business Name): MR. BRYAN MARVIN CARROLL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13934 TINSLEY CT
HOUSTON TX
77014-2066
US

IV. Provider business mailing address

13934 TINSLEY CT
HOUSTON TX
77014-2066
US

V. Phone/Fax

Practice location:
  • Phone: 443-415-9530
  • Fax:
Mailing address:
  • Phone: 443-415-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: