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General NPI Number Information
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NPI Number | 1760693956
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Entity Type | Individual
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Provider Name | JOHN STEVEN CARLSON PHD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 601 ABBOTT RD SUITE 101
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City | EAST LANSING
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State | MI
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Zip | 48823-3366
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Country | US
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Telephone | 517-282-7717
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Fax |
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Provider Business Mailing Address
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Address Line | 964 LANTERN HILL DR
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City | EAST LANSING
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State | MI
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Zip | 48823-2832
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Country | US
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Telephone | 517-282-7717
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6301011692
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 6301011692
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License Number State | MI
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