MEDICARE: JESSICA CARROLL LPCA, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	270481	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104329598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CARROLL LPCA, NCC

Provider Business Mailing Address
First Line	:	605 SMUGGLERS NOTCH DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-4394
Country	:	US
Telephone Number	:	606-272-4902
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-1986
Country	:	US
Telephone Number	:	606-404-2966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	07/23/2021

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