Provider Demographics
NPI:1750764841
Name:CARROLL, KARI D (MS)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:D
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 1:2311 E BURNSIDE ST
Mailing Address - Street 2:UNIT 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1655
Mailing Address - Country:US
Mailing Address - Phone:210-542-5288
Mailing Address - Fax:
Practice Address - Street 1:2311 E BURNSIDE ST
Practice Address - Street 2:UNIT 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1655
Practice Address - Country:US
Practice Address - Phone:503-773-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORR3901101YP2500X
ORR3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional