Provider Demographics
NPI:1922032465
Name:KARSON, MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KARSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 S VINE ST
Mailing Address - Street 2:DU-GSPP
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80208-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2460 S VINE ST
Practice Address - Street 2:DU-GSPP
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80208-0001
Practice Address - Country:US
Practice Address - Phone:303-871-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2705103T00000X, 103TC0700X
103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02385Medicare ID - Type Unspecified