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NPI Code Detail

MEDICARE: MR. MARTY L CARROLL LPC

MEDICARE: MR. MARTY L CARROLL LPC
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
1101YP2500XProfessional Counselor3749LA

General Provider Information

NPI Number : 1750422564
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARTY L CARROLL LPC
Provider Business Mailing Address
First Line : 115 HIGHWAY 2
Second Line :
City : STERLINGTON
State : LA
Zip : 71280-3009
Country : US
Telephone Number : 318-665-9950
Fax Number : 318-665-9975
Provider Business Practice Location Address
First Line : 115 HIGHWAY 2
Second Line :
City : STERLINGTON
State : LA
Zip : 71280-3009
Country : US
Telephone Number : 318-665-9950
Fax Number : 318-665-9975
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 10/30/2008

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