Provider Demographics
NPI:1003455478
Name:CARLSON, AMY LOU (NCC, LPC, CSATP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOU
Last Name:CARLSON
Suffix:
Gender:F
Credentials:NCC, LPC, CSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 NW 71ST TER
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-2460
Mailing Address - Country:US
Mailing Address - Phone:816-606-6819
Mailing Address - Fax:
Practice Address - Street 1:10031 NW 71ST TER
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-2460
Practice Address - Country:US
Practice Address - Phone:816-606-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015040235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional