Provider Demographics
NPI:1174894638
Name:PROCTOR, CARRIE ANN (LPC)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANN
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:LPC
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 1199
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-1199
Mailing Address - Country:US
Mailing Address - Phone:512-736-1665
Mailing Address - Fax:
Practice Address - Street 1:600 ROUND ROCK WEST
Practice Address - Street 2:SUITE 404
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5005
Practice Address - Country:US
Practice Address - Phone:512-736-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional