Provider Demographics
NPI:1407973100
Name:COULSON, CAROL A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:COULSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CROSSWINDS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4303
Mailing Address - Country:US
Mailing Address - Phone:314-412-1445
Mailing Address - Fax:
Practice Address - Street 1:225 S MERAMEC AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:314-412-1445
Practice Address - Fax:314-863-5904
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0057451041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL196525OtherBLUE CROSS BLUE SHIELD
IL211630Medicare ID - Type UnspecifiedWPS MEDICARE