Provider Demographics
NPI:1023362613
Name:CARLSON, MATTHEW WILLIAM (LPC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:CARLSON
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 SW 32ND TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5242
Mailing Address - Country:US
Mailing Address - Phone:970-363-4031
Mailing Address - Fax:970-360-1011
Practice Address - Street 1:5963 TURNSTONE PL
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-5271
Practice Address - Country:US
Practice Address - Phone:970-363-4031
Practice Address - Fax:970-360-1011
Is Sole Proprietor?:No
Enumeration Date:2012-11-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013334101YM0800X
TX86425101YP2500X
COLPC.0012306101YP2500X
COACD0000621101YA0400X
FLTPMC1178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)