Provider Demographics
NPI:1831678838
Name:CARSON, ALISHA S
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:S
Last Name:CARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 SEQUOYAH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6530
Mailing Address - Country:US
Mailing Address - Phone:405-761-8072
Mailing Address - Fax:
Practice Address - Street 1:1508 SEQUOYAH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6530
Practice Address - Country:US
Practice Address - Phone:405-761-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health