Provider Demographics
NPI:1841340577
Name:MYRICK, CARROLL THOMAS (LPC-INTERN)
Entity type:Individual
Prefix:MR
First Name:CARROLL
Middle Name:THOMAS
Last Name:MYRICK
Suffix:
Gender:M
Credentials:LPC-INTERN
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 274
Mailing Address - Street 2:
Mailing Address - City:COOKVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75558-0274
Mailing Address - Country:US
Mailing Address - Phone:903-856-6001
Mailing Address - Fax:903-856-0465
Practice Address - Street 1:200 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1348
Practice Address - Country:US
Practice Address - Phone:903-856-6001
Practice Address - Fax:903-856-0465
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional