Provider Demographics
NPI:1356546931
Name:CARRILLO, ANNA MARIE (LPC-S, RPT-S)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LPC-S, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4237
Mailing Address - Country:US
Mailing Address - Phone:432-853-3645
Mailing Address - Fax:
Practice Address - Street 1:835 TOWER DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4237
Practice Address - Country:US
Practice Address - Phone:432-853-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health