Provider Demographics
NPI:1326361213
Name:CARR, KEVIN CHRISTOPHER (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:CARR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 KUBLI RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-8632
Mailing Address - Country:US
Mailing Address - Phone:541-301-5306
Mailing Address - Fax:541-846-6733
Practice Address - Street 1:1399 KUBLI RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-8632
Practice Address - Country:US
Practice Address - Phone:541-301-5306
Practice Address - Fax:541-846-6733
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670565Medicaid