Provider Demographics
NPI:1134586753
Name:CARROLL, CLEO
Entity type:Individual
Prefix:MR
First Name:CLEO
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-7310
Mailing Address - Country:US
Mailing Address - Phone:225-270-8828
Mailing Address - Fax:225-590-3324
Practice Address - Street 1:2965 ELGIN ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7310
Practice Address - Country:US
Practice Address - Phone:225-270-8828
Practice Address - Fax:225-590-3324
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health