Provider Demographics
NPI:1629848825
Name:CARSON, BRIAN MCKINLEY
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MCKINLEY
Last Name:CARSON
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 1:500 ALLERTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1519
Mailing Address - Country:US
Mailing Address - Phone:650-599-9955
Mailing Address - Fax:
Practice Address - Street 1:500 ALLERTON ST FL 2
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1519
Practice Address - Country:US
Practice Address - Phone:650-599-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)