Provider Demographics
NPI:1376983528
Name:CARSON, TRISHA ANN (LPCC)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN
Last Name:CARSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:ANN
Other - Last Name:GOENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 FOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2205
Mailing Address - Country:US
Mailing Address - Phone:937-593-9600
Mailing Address - Fax:
Practice Address - Street 1:221 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2205
Practice Address - Country:US
Practice Address - Phone:937-593-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1300213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional