Provider Demographics
NPI:1407415342
Name:CARROL, BETTY (LMHC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:CARROL
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKLEY SEAVER DR STE 213
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1960
Mailing Address - Country:US
Mailing Address - Phone:904-802-8883
Mailing Address - Fax:
Practice Address - Street 1:321 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4421
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:321-697-5661
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3066106H00000X
FLMH22557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMT3066Medicaid