Healthcare Provider Details

I. General information

NPI: 1760693956
Provider Name (Legal Business Name): JOHN STEVEN CARLSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ABBOTT RD SUITE 101
EAST LANSING MI
48823-3366
US

IV. Provider business mailing address

964 LANTERN HILL DR
EAST LANSING MI
48823-2832
US

V. Phone/Fax

Practice location:
  • Phone: 517-282-7717
  • Fax:
Mailing address:
  • Phone: 517-282-7717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301011692
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6301011692
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: