MEDICARE: JAMES B. CARROLL LCPC

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	180004287	IL
2	101Y00000X	Counselor	18004287	IL

General Provider Information

NPI Number	:	1760684674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES B. CARROLL LCPC

Provider Business Mailing Address
First Line	:	131 LINCOLN PLACE CT STE 406
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5825
Country	:	US
Telephone Number	:	618-631-2683
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 LINCOLN PLACE CT STE 406
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5825
Country	:	US
Telephone Number	:	618-631-2683
Fax Number	:

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

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	07/03/2025

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