Healthcare Provider Details

I. General information

NPI: 1134973225
Provider Name (Legal Business Name): DARRIN CARLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 1ST AVE
SPOKANE WA
99202-1501
US

IV. Provider business mailing address

1250 SE COMMERCIAL DR
COLLEGE PLACE WA
99324-9721
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4651
  • Fax:
Mailing address:
  • Phone: 509-838-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61538440
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMC61538440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: