Provider Demographics
NPI:1417391608
Name:CARLSON, ASA RAYMON (MA)
Entity Type:Individual
Prefix:
First Name:ASA
Middle Name:RAYMON
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3541
Mailing Address - Country:US
Mailing Address - Phone:541-743-4340
Mailing Address - Fax:541-743-4369
Practice Address - Street 1:149 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6215
Practice Address - Country:US
Practice Address - Phone:541-344-0031
Practice Address - Fax:541-344-0772
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health