Provider Demographics
NPI:1497214944
Name:CARLSON, ZACHARY ARIN
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ARIN
Last Name:CARLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45421 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1948
Mailing Address - Country:US
Mailing Address - Phone:661-839-9043
Mailing Address - Fax:
Practice Address - Street 1:1216 W AVENUE J STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2944
Practice Address - Country:US
Practice Address - Phone:661-434-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst