MEDICARE: MICHAEL CARR LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1457	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019716	OTHER	ND	BCBS PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710922059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CARR LAC

Provider Business Mailing Address
First Line	:	7965 COUNTY 1
Second Line	:
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-8914
Country	:	US
Telephone Number	:	701-253-6326
Fax Number	:

Provider Business Practice Location Address
First Line	:	7965 COUNTY 1
Second Line	:
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-8914
Country	:	US
Telephone Number	:	701-253-6326
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	10/21/2010

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