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General NPI Number Information
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NPI Number | 1720150436
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Entity Type | Individual
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Provider Name | SERVIO A. CARROLL NCSP, LPC
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 108 S THURMOND ST
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City | SHERIDAN
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State | WY
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Zip | 82801-4145
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Country | US
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Telephone | 307-752-6251
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Fax | 307-672-6251
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Provider Business Mailing Address
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Address Line | 511 AIRPORT RD
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City | SHERIDAN
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State | WY
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Zip | 82801-5801
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Country | US
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Telephone | 307-672-6251
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Fax | 307-672-6251
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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 | LPC- NO. 12
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License Number State | WY
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