Individual
MS. CAROL LYNN PASEWARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., LPC
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 412-3112
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 956-3847
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2004000710
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437294816
CEDAR RIDGE NPI
MO
01
—
1649269622
GROUP BILLING NPI
MO
Enumeration date
07/07/2005
Last updated
01/22/2020
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