Healthcare Provider Details

I. General information

NPI: 1356063614
Provider Name (Legal Business Name): KIRSTEN LISA CARLSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S 18TH AVE
STURGEON BAY WI
54235-1401
US

IV. Provider business mailing address

323 S 18TH AVE
STURGEON BAY WI
54235-1401
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-0510
  • Fax:
Mailing address:
  • Phone: 920-746-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0006368
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5978-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: