Provider Demographics
NPI:1801653258
Name:CARSON, TONYA LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LEIGH
Last Name:CARSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HI TOP RD
Mailing Address - Street 2:
Mailing Address - City:INGRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78025-5516
Mailing Address - Country:US
Mailing Address - Phone:830-370-4799
Mailing Address - Fax:
Practice Address - Street 1:125 HI TOP RD
Practice Address - Street 2:
Practice Address - City:INGRAM
Practice Address - State:TX
Practice Address - Zip Code:78025-5516
Practice Address - Country:US
Practice Address - Phone:830-370-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16000101YA0400X
TX85562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)