Provider Demographics
NPI:1467984005
Name:CARSON, GEORGE IV (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:CARSON
Suffix:IV
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 VALLEY VIEW LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-4955
Mailing Address - Country:US
Mailing Address - Phone:214-736-8376
Mailing Address - Fax:
Practice Address - Street 1:2825 VALLEY VIEW LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4955
Practice Address - Country:US
Practice Address - Phone:214-736-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-25582103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst