Provider Demographics
NPI:1659428233
Name:CARLSON, JOANNE E (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:E
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 MISTY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5592
Mailing Address - Country:US
Mailing Address - Phone:281-980-2444
Mailing Address - Fax:281-980-2444
Practice Address - Street 1:16300 KATY FWY STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1600
Practice Address - Country:US
Practice Address - Phone:281-646-0228
Practice Address - Fax:281-492-2751
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX024321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOS96M2Medicaid
TXOS96M2Medicaid