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General NPI Number Information
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NPI Number | 1124837158
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Entity Type | Individual
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Provider Name | ELIZABETH JOY CARLSON BA
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Gender | Female
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 206 N KNUDSON ST
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-7568
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Country | US
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Telephone | 360-688-6458
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Fax |
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Provider Business Mailing Address
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Address Line | 2508 W OKANOGAN AVE
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City | POST FALLS
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State | ID
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Zip | 83854-8572
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Country | US
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Telephone | 360-688-6458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CBT.CB.61649710
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License Number State | WA
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