Provider Demographics
NPI:1386833861
Name:FRANK, CARTER LEROY (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:CARTER
Middle Name:LEROY
Last Name:FRANK
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HAZEL AVE.
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1631
Mailing Address - Country:US
Mailing Address - Phone:618-960-0941
Mailing Address - Fax:
Practice Address - Street 1:111 HAZEL AVE.
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-1631
Practice Address - Country:US
Practice Address - Phone:618-960-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-02592101YP2500X
MO002143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional