MEDICARE: MICHELLE CARLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578401246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CARLSON

Provider Business Mailing Address
First Line	:	2 ACADEMY ST RM 201
Second Line	:
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E 3RD ST STE 5
Second Line	:
City	:	JAMESTOWN
State	:	NY
Zip	:	14701-5433
Country	:	US
Telephone Number	:	716-661-8330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ MICHELLE CARLSON ” Practice Location

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