MEDICARE: JEFFREY JOHN CARSON MA, LADC

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
2	101YM0800X	Mental Health Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	1269	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C10131	OTHER	NV	CPCI

General Provider Information

NPI Number	:	1801130232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY JOHN CARSON MA, LADC

Provider Business Mailing Address
First Line	:	1405 SAN JUAN HILLS DR
Second Line	:	UNIT 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6390
Country	:	US
Telephone Number	:	770-364-4402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 SAN JUAN HILLS DR UNIT 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6390
Country	:	US
Telephone Number	:	770-364-4402
Fax Number	:

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	04/08/2019

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