Provider Demographics
NPI:1891107306
Name:CARLSEN, LISA JOANN (MA, CBT, RBT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOANN
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:MA, CBT, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 IRON ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4123
Mailing Address - Country:US
Mailing Address - Phone:206-484-5246
Mailing Address - Fax:
Practice Address - Street 1:4000 FLYNN ST
Practice Address - Street 2:SPC 110
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6055
Practice Address - Country:US
Practice Address - Phone:206-484-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60777159103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst