Provider Demographics
NPI:1861572372
Name:BELL, CAROL (MS)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:BELL
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 1:4003 80TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4995
Mailing Address - Country:US
Mailing Address - Phone:262-484-5095
Mailing Address - Fax:262-484-5071
Practice Address - Street 1:4003 80TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4995
Practice Address - Country:US
Practice Address - Phone:262-484-5095
Practice Address - Fax:262-484-5071
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2246101YA0400X
WI1021-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39647100Medicaid