=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861749343
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE A CARR LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2012
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 W JACKSON ST
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65706-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-224-5262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 777 W JACKSON ST
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65706-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-224-5262
-----------------------------------------------------
Fax | 800-708-6996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2012024650
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------