Provider Demographics
NPI:1750606828
Name:CARLSON, RAY & ASSOCIATES, PS, INC.
Entity type:Organization
Organization Name:CARLSON, RAY & ASSOCIATES, PS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:425-454-1189
Mailing Address - Street 1:11119 NE 68TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7188
Mailing Address - Country:US
Mailing Address - Phone:425-454-1189
Mailing Address - Fax:
Practice Address - Street 1:2200 112TH AVE NE STE 140
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2951
Practice Address - Country:US
Practice Address - Phone:425-454-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1538212972OtherINDIVIDUAL PROVIDER