Provider Demographics
NPI:1548565427
Name:CARLSTON, AMBER T (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:T
Last Name:CARLSTON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 S 1630 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3010
Mailing Address - Country:US
Mailing Address - Phone:801-557-9972
Mailing Address - Fax:801-557-9972
Practice Address - Street 1:4437 S 1630 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3010
Practice Address - Country:US
Practice Address - Phone:801-557-9972
Practice Address - Fax:801-557-9972
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6719406-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional