Active NPI
Servio A. Carroll, NCSP, LPC
- Professional Counselor
- Sheridan, WY
National Provider Identifier
1720150436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC- NO. 12
- Practice address
- 108 S Thurmond St
Sheridan, WY 82801-4145 - Phone
- (307) 752-6251
- Fax
- (307) 672-6251
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC- NO. 12 | WY | Primary |
Addresses
Primary practice location
108 S Thurmond St
Sheridan, WY 82801-4145
Mailing address
511 Airport Rd
Sheridan, WY 82801-5801
Phone (307) 672-6251
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC- NO. 12 | WY | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720150436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 AIRPORT RD",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828015801",
"telephone_number": "307-672-6251",
"fax_number": "307-672-6251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 S THURMOND ST",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828014145",
"telephone_number": "307-752-6251",
"fax_number": "307-672-6251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "SERVIO",
"middle_name": "A.",
"name_prefix": "Mr.",
"credential": "NCSP, LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WY",
"license": "LPC- NO. 12",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.