Provider Demographics
NPI:1790015840
Name:CARROLL, PAULA LOUISE (MS)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:LOUISE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 W. GREENE ST.
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1637
Mailing Address - Country:US
Mailing Address - Phone:515-993-4535
Mailing Address - Fax:515-993-3845
Practice Address - Street 1:2111 W. GREENE ST.
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1637
Practice Address - Country:US
Practice Address - Phone:515-993-4535
Practice Address - Fax:515-993-3845
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health