Provider Demographics
NPI:1184477499
Name:CARLSON, ROBERT BRIAN (LMFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRIAN
Last Name:CARLSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 S KEYSTONE ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2728
Mailing Address - Country:US
Mailing Address - Phone:818-848-9158
Mailing Address - Fax:
Practice Address - Street 1:232 S KEYSTONE ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2728
Practice Address - Country:US
Practice Address - Phone:818-848-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health