Doctor Name: | LISA CARROLL |
NPI Number: | 1083083182 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2013011413 |
Business Practice Address: | 141 N Meramec Ave Suite 109 Clayton, MO - 631053750 |
Business Phone Number: | 7739806962 |
Business Fax Number: | |
Mailing Address: | 5533 Connecticut St, Suite 109 SAINT LOUIS |
State: | MO |
Postal Code: | 631391701 |
Phone Number: | 7733685956 |
Fax Number: | |
NPI Enumeration Date: | 09/18/2015 |
NPI Last Update Date: | 09/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2013011413 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |