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General NPI Number Information
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NPI Number | 1205913290
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Entity Type | Individual
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Provider Name | DAVID CARROLL PSYD, LP
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 1751 TOWER DR W STE 200
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City | STILLWATER
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State | MN
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Zip | 55082-7596
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Country | US
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Telephone | 651-439-2059
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Fax | 888-675-8262
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Provider Business Mailing Address
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Address Line | 588 101ST AVE N
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City | NAPLES
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State | FL
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Zip | 34108-3201
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Country | US
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Telephone | 651-439-2059
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Fax | 888-675-8262
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2633
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License Number State | MN
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