Provider Demographics
NPI:1326582941
Name:CARLSON, DAVID K (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:CARLSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 LEERAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9233
Mailing Address - Country:US
Mailing Address - Phone:405-819-9655
Mailing Address - Fax:
Practice Address - Street 1:5112 LEERAY RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9233
Practice Address - Country:US
Practice Address - Phone:405-819-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical