Provider Demographics
NPI:1033562111
Name:RICE, CAROL (CHT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:EISTERHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1803 SUN VALLEY DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2178
Mailing Address - Country:US
Mailing Address - Phone:888-604-9997
Mailing Address - Fax:
Practice Address - Street 1:1803 SUN VALLEY DR
Practice Address - Street 2:SUITE D
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2178
Practice Address - Country:US
Practice Address - Phone:888-604-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO09235008103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral