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General NPI Number Information
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NPI Number | 1528478286
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Entity Type | Individual
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Provider Name | THOMAS CARROLL LPC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2014
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Last Update Date | 08/14/2022
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Provider Practice Location Address
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Address Line | 1716 FORDEM AVE
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City | MADISON
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State | WI
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Zip | 53704-4604
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Country | US
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Telephone | 608-221-3511
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Fax | 608-221-3514
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Provider Business Mailing Address
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Address Line | 5408 WILD CHERRY LN
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City | MCFARLAND
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State | WI
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Zip | 53558-8922
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Country | US
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Telephone | 773-318-5916
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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 | 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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