Provider Demographics
NPI:1033275185
Name:CARLSON, NOLAN KAY (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:KAY
Last Name:CARLSON
Suffix:
Gender:M
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 COLUMBIAN RD
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-9618
Mailing Address - Country:US
Mailing Address - Phone:785-456-2715
Mailing Address - Fax:785-456-7548
Practice Address - Street 1:4750 COLUMBIAN RD
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-9618
Practice Address - Country:US
Practice Address - Phone:785-456-2715
Practice Address - Fax:785-456-7548
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health