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General NPI Number Information
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NPI Number | 1497126882
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Entity Type | Individual
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Provider Name | SUSAN KATHRYN CARLSON MA COUNSELING
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 3400 STATE STREET SUITE G750
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City | SALEM
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State | OR
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Zip | 97301-7012
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Country | US
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Telephone | 541-900-4285
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Fax | 888-810-2993
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Provider Business Mailing Address
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Address Line | 272 NW MEDICAL LOOP SUITE E
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City | ROSEBURG
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State | OR
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Zip | 97471-5545
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Country | US
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Telephone | 541-900-4285
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Fax | 888-810-2993
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R4988
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C6868
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License Number State | OR
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