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General NPI Number Information
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NPI Number | 1427359561
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Entity Type | Individual
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Provider Name | MARY ELLEN CARLSON
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Gender | Female
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 2205 ROCKY MOUNTAIN AVE UNIT 302
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City | LOVELAND
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State | CO
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Zip | 80538-8843
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Country | US
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Telephone | 253-394-1054
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 ROCKY MOUNTAIN AVE UNIT 302
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City | LOVELAND
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State | CO
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Zip | 80538-8843
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Country | US
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Telephone | 253-394-1054
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CG60132886
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0014899
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License Number State | CO
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