Provider Demographics
NPI:1497939649
Name:CARLSON, THOMAS (MA LPCC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 STATE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2498
Mailing Address - Country:US
Mailing Address - Phone:513-232-3400
Mailing Address - Fax:513-232-1900
Practice Address - Street 1:7495 STATE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2498
Practice Address - Country:US
Practice Address - Phone:513-232-3400
Practice Address - Fax:513-232-1900
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0002275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000554980OtherANTHEM PIN