Provider Demographics
NPI:1053474270
Name:CARSON, HOLLY EDEN (MA, LPC, LCSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:EDEN
Last Name:CARSON
Suffix:
Gender:F
Credentials:MA, LPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27897
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-1397
Mailing Address - Country:US
Mailing Address - Phone:314-995-1970
Mailing Address - Fax:636-561-4796
Practice Address - Street 1:316 S 2ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-3402
Practice Address - Country:US
Practice Address - Phone:314-995-1970
Practice Address - Fax:636-561-4796
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000447101YP2500X
MO0028231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical