Provider Demographics
NPI:1073937298
Name:CARLSON, GERI (MA, MMIN)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA, MMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8182 STATE ROAD 17
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8282
Mailing Address - Country:US
Mailing Address - Phone:574-941-2300
Mailing Address - Fax:
Practice Address - Street 1:8182 STATE ROAD 17
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8282
Practice Address - Country:US
Practice Address - Phone:574-941-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral