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General NPI Number Information
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NPI Number | 1659381507
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Entity Type | Individual
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Provider Name | STANLEY E CARLSON MDIV,LMHP,CPC,LADC,
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 230 E 22ND ST SUITE #3
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City | FREMONT
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State | NE
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Zip | 68025-2661
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Country | US
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Telephone | 402-721-8805
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Fax | 412-727-4839
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Provider Business Mailing Address
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Address Line | 230 E 22ND ST SUITE #3
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City | FREMONT
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State | NE
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Zip | 68025-2661
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Country | US
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Telephone | 402-721-8805
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Fax | 412-727-4839
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 683
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License Number State | NE
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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 | 2105
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1200
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18
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License Number State | NE
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