Provider Demographics
NPI:1497273759
Name:KIM C. CARSON
Entity Type:Organization
Organization Name:KIM C. CARSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-743-2324
Mailing Address - Street 1:201 W. VIRGINIA SUITE 203
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069
Mailing Address - Country:US
Mailing Address - Phone:972-743-2324
Mailing Address - Fax:
Practice Address - Street 1:201 W. VIRGINIA SUITE 203
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:972-743-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19454101Y00000X
TX68346101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty