Provider Demographics
NPI:1952794919
Name:CARLSON, BARBARA (MS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4828
Mailing Address - Country:US
Mailing Address - Phone:503-489-0567
Mailing Address - Fax:503-489-0568
Practice Address - Street 1:18000 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4828
Practice Address - Country:US
Practice Address - Phone:503-489-0567
Practice Address - Fax:503-489-0568
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health