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General NPI Number Information
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NPI Number | 1285327387
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Entity Type | Individual
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Provider Name | NATHAN KANTRELL CARROLL M.ED, NCC., P-LPC
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Gender | Male
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 2094 OLD TAYLOR RD STE 155
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City | OXFORD
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State | MS
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Zip | 38655-5019
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Country | US
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Telephone | 662-985-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 2094 OLD TAYLOR RD STE 155
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City | OXFORD
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State | MS
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Zip | 38655-5019
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Country | US
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Telephone | 662-985-1844
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P-0923
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License Number State | MS
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