Provider Demographics
NPI:1770688103
Name:CARSON, ALAN KEITH
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:KEITH
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 1:1136 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-2716
Mailing Address - Country:US
Mailing Address - Phone:325-658-6138
Mailing Address - Fax:325-658-8104
Practice Address - Street 1:218 PULLIAM ST.
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76905
Practice Address - Country:US
Practice Address - Phone:325-658-6138
Practice Address - Fax:325-658-8104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101YA0400XOtherTAXONOMY