Provider Demographics
NPI:1891076089
Name:TRICK, CARLA M (MS)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:TRICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:M
Other - Last Name:TRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:3411 DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-5789
Mailing Address - Country:US
Mailing Address - Phone:417-257-9152
Mailing Address - Fax:
Practice Address - Street 1:3411 DIVISION DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-5789
Practice Address - Country:US
Practice Address - Phone:417-257-9152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012003619OtherSTATE LICENSE