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General NPI Number Information
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NPI Number | 1578449278
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Entity Type | Individual
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Provider Name | DAVID LEE CARLSON JD, CHC
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Gender | Male
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 405 S FARWELL ST STE 6
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2701
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Country | US
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Telephone | 715-456-0252
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2094
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City | EAU CLAIRE
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State | WI
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Zip | 54702-2094
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Country | US
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Telephone | 715-456-0252
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6689-125
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License Number State | WI
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