Healthcare Provider Details

I. General information

NPI: 1346835519
Provider Name (Legal Business Name): CARLSON COUNSELING & PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E 86TH ST STE 201-R
INDIANAPOLIS IN
46240-1850
US

IV. Provider business mailing address

911 E 86TH ST STE 201-R
INDIANAPOLIS IN
46240-1850
US

V. Phone/Fax

Practice location:
  • Phone: 317-406-8306
  • Fax: 317-406-8306
Mailing address:
  • Phone: 317-406-8306
  • Fax: 317-406-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELANIE A. CARLSON
Title or Position: CEO
Credential: LCSW, MSW
Phone: 317-406-8306