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General NPI Number Information
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NPI Number | 1386941524
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Entity Type | Individual
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Provider Name | RENEE DIANE CARSON M.A.
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Gender | Female
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 34556 N APPALOOSA WAY
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85144-4431
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Country | US
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Telephone | 480-793-2622
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Fax |
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Provider Business Mailing Address
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Address Line | 34556 N APPALOOSA WAY
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85144-4431
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Country | US
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Telephone | 480-793-2622
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-10-7382
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | C62572485734
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BEH-001235
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License Number State | AZ
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