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General NPI Number Information
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NPI Number | 1770101297
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Entity Type | Individual
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Provider Name | CANNA O'CARROLL LPC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 650 E. WALNUT
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City | ELIZABETH
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State | CO
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Zip | 80107
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Country | US
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Telephone | 720-284-4538
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Fax |
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Provider Business Mailing Address
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Address Line | 5440 FAWN RIDGE WAY
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City | CASTLE ROCK
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State | CO
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Zip | 80104-3357
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Country | US
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Telephone | 720-284-4538
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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 | LPC.0016270
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License Number State | CO
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