Healthcare Provider Details

I. General information

NPI: 1366160145
Provider Name (Legal Business Name): JOEY CARLSON LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E VALLEY RD UNIT 102
BASALT CO
81621-8352
US

IV. Provider business mailing address

1450 E VALLEY RD UNIT 102
BASALT CO
81621-8352
US

V. Phone/Fax

Practice location:
  • Phone: 970-927-4666
  • Fax:
Mailing address:
  • Phone: 970-927-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADC.0002795
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: