Provider Demographics
NPI:1346617198
Name:CARLSON, TERRY JO (RN, CADC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:JO
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN, CADC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 42ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3076
Mailing Address - Country:US
Mailing Address - Phone:319-377-2161
Mailing Address - Fax:319-377-2094
Practice Address - Street 1:1642 42ND ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3076
Practice Address - Country:US
Practice Address - Phone:319-377-2161
Practice Address - Fax:319-377-2094
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001655101YM0800X
IA13071101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)