Provider Demographics
NPI:1255464418
Name:CARLSON, BETTE (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E RIVERPARK LN
Mailing Address - Street 2:STE 200
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6551
Mailing Address - Country:US
Mailing Address - Phone:208-344-5457
Mailing Address - Fax:208-343-5165
Practice Address - Street 1:600 E RIVERPARK LN
Practice Address - Street 2:STE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6551
Practice Address - Country:US
Practice Address - Phone:208-344-5457
Practice Address - Fax:208-343-5165
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW5981041C0700X
IDLMFT3059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist