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General NPI Number Information
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NPI Number | 1679021166
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Entity Type | Individual
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Provider Name | MARY L CARLSON MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 1300 S UNIVERSITY DR STE 306
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City | FORT WORTH
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State | TX
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Zip | 76107-5746
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Country | US
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Telephone | 844-824-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 308 S FRIENDSWOOD DR STE 200
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-3989
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Country | US
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Telephone | 844-824-8775
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 79257
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 79257
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License Number State | TX
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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 | 2014030086
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License Number State | MO
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