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General NPI Number Information
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NPI Number | 1669856068
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Entity Type | Individual
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Provider Name | BRANDON BECK CARROLL PLP
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Gender | Male
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 307 N MAIN ST
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City | WINDSOR
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State | MO
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Zip | 65360-1449
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Country | US
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Telephone | 888-403-1071
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Fax | 660-647-3617
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Provider Business Mailing Address
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Address Line | 1800 COMMUNITY
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City | CLINTON
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State | MO
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Zip | 64735-8804
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Country | US
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Telephone | 660-885-8131
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 2019039855
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License Number State | MO
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