Provider Demographics
NPI:1457419103
Name:CARSON, PEGGY L (MS LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:L
Last Name:CARSON
Suffix:
Gender:F
Credentials:MS LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 DEEP WATER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68527-1858
Mailing Address - Country:US
Mailing Address - Phone:402-483-0680
Mailing Address - Fax:402-483-0680
Practice Address - Street 1:341 DEEP WATER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68527-1858
Practice Address - Country:US
Practice Address - Phone:402-483-0680
Practice Address - Fax:402-483-0680
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1474101YM0800X
NE157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
84589OtherBCBS
84589OtherBCBS