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General NPI Number Information
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NPI Number | 1316346547
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Entity Type | Individual
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Provider Name | OLIVIA LARAE CARRELL LPC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 15 MONROE STREET NE
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-229-6045
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Fax |
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Provider Business Mailing Address
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Address Line | 2306 MARY NIBLACK RD
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City | ARDMORE
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State | OK
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Zip | 73401-8482
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Country | US
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Telephone | 580-229-6045
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7618
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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