Provider Demographics
NPI:1851012181
Name:PTACEK, CAROL DAIGLE (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DAIGLE
Last Name:PTACEK
Suffix:
Gender:F
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:PO BOX 2470
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-2470
Mailing Address - Country:US
Mailing Address - Phone:520-780-6231
Mailing Address - Fax:
Practice Address - Street 1:1126 MO'S WAY
Practice Address - Street 2:#2470
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-2470
Practice Address - Country:US
Practice Address - Phone:520-780-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional