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General NPI Number Information
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NPI Number | 1750715041
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Entity Type | Organization
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Legal Business Name | SCOTT R CARLSON
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 80 S GIBSON RD APT. # 2312
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City | HENDERSON
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State | NV
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Zip | 89012-2432
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Country | US
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Telephone | 702-306-6612
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Fax |
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Provider Business Mailing Address
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Address Line | 80 S GIBSON RD APT. # 2312
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City | HENDERSON
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State | NV
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Zip | 89012-2432
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Country | US
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Telephone | 702-306-6612
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Fax |
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Authorized Official
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Title or Position | QBA
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Name | MR. SCOTT R CARLSON
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Credential |
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Telephone | 702-306-6612
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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 |
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License Number State |
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