MEDICARE: AMBERLE DAWN CARROLL BA

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	101YM0800X	Mental Health Counselor	CTB-2024-0512	NM
2	101YM0800X	Mental Health Counselor	LAC-22004	AZ

General Provider Information

NPI Number	:	1124766308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBERLE DAWN CARROLL BA

Provider Business Mailing Address
First Line	:	3407 EDGEMONT DR
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-4218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7441 BARTLETT ST NE STE 1B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-5916
Country	:	US
Telephone Number	:	505-600-6631
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	10/21/2025

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