Provider Demographics
NPI:1184975328
Name:DIAL, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:DIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8632
Mailing Address - Country:US
Mailing Address - Phone:816-678-6728
Mailing Address - Fax:
Practice Address - Street 1:5301 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2647
Practice Address - Country:US
Practice Address - Phone:816-678-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMFT 2419106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist