Healthcare Provider Details

I. General information

NPI: 1275665275
Provider Name (Legal Business Name): STEVEN CHARLES CARLSON M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E TWELVE OAKS TER
MUSTANG OK
73064-4915
US

IV. Provider business mailing address

7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK
73145-8716
US

V. Phone/Fax

Practice location:
  • Phone: 405-206-8389
  • Fax:
Mailing address:
  • Phone: 405-582-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: