Provider Demographics
NPI:1083903520
Name:CARLSON, MEGAN (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 MONTIANO LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8769
Mailing Address - Country:US
Mailing Address - Phone:505-750-3467
Mailing Address - Fax:
Practice Address - Street 1:1433 MONTIANO LOOP SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-8769
Practice Address - Country:US
Practice Address - Phone:505-750-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0167751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional