Healthcare Provider Details

I. General information

NPI: 1275458390
Provider Name (Legal Business Name): MARK CALEB CARLSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11952 GRAY ST
WESTMINSTER CO
80020-5906
US

IV. Provider business mailing address

3649 N GARFIELD ST
DENVER CO
80205-3747
US

V. Phone/Fax

Practice location:
  • Phone: 720-244-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024384
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: