Provider Demographics
NPI:1285327387
Name:CARROLL, NATHAN KANTRELL (MED, NCC, P-LPC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:KANTRELL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MED, NCC, P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 OLD TAYLOR RD STE 155
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5019
Mailing Address - Country:US
Mailing Address - Phone:662-985-1844
Mailing Address - Fax:
Practice Address - Street 1:2094 OLD TAYLOR RD STE 155
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5019
Practice Address - Country:US
Practice Address - Phone:662-985-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0923101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor