Active NPI
Brandon Beck Carroll, PLP
- Cognitive & Behavioral Psychologist
- Windsor, MO
National Provider Identifier
1669856068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 2019039855
- Practice address
- 307 N Main St
Windsor, MO 65360-1449 - Phone
- (888) 403-1071
- Fax
- (660) 647-3617
- NPI assigned
- Jul 15, 2015
- Last updated
- Oct 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 2019039855 | MO | Primary |
Addresses
Primary practice location
307 N Main St
Windsor, MO 65360-1449
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019039855 | MO | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571184000000",
"number": "1669856068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 COMMUNITY",
"city": "CLINTON",
"state": "MO",
"postal_code": "647358804",
"telephone_number": "660-885-8131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 N MAIN ST",
"city": "WINDSOR",
"state": "MO",
"postal_code": "653601449",
"telephone_number": "888-403-1071",
"fax_number": "660-647-3617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "BRANDON",
"middle_name": "BECK",
"credential": "PLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-15",
"last_updated": "2019-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MO",
"license": "2019039855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windsor, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.