Basic Information
Provider Information
NPI: 1174946685
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARLSON
FirstName: MARGARET (MEG)
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8205 SPAIN RD NE
Address2: SUITE 106
City: ALBUQUERQUE
State: NM
PostalCode: 871093179
CountryCode: US
TelephoneNumber: 5053847352
FaxNumber: 5052747338
Practice Location
Address1: 1805 CARLISLE BLVD NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871104905
CountryCode: US
TelephoneNumber: 5059334639
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/04/2014
LastUpdateDate: 02/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XT-0161051NMY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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