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General NPI Number Information
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NPI Number | 1427556240
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Entity Type | Individual
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Provider Name | NICOLE CARLSON LCSW, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 2600 E SOUTHERN AVE STE C3
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City | TEMPE
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State | AZ
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Zip | 85282-7609
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Country | US
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Telephone | 626-515-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHERN AVE STE C3
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City | TEMPE
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State | AZ
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Zip | 85282-7609
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Country | US
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Telephone | 626-515-8875
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Fax | 480-879-3048
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-19986
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 276452
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 276452
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License Number State | AZ
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