Provider Demographics
NPI:1598205577
Name:CARLSON, AMY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-8803
Mailing Address - Country:US
Mailing Address - Phone:720-935-5813
Mailing Address - Fax:
Practice Address - Street 1:1015 37TH AVENUE CT UNIT 102
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2500
Practice Address - Country:US
Practice Address - Phone:720-935-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health