Provider Demographics
NPI:1366563918
Name:CARLSON, JAMES ANDREW (MFT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4323
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93140-4323
Mailing Address - Country:US
Mailing Address - Phone:888-202-8477
Mailing Address - Fax:805-682-0484
Practice Address - Street 1:1815 STATE ST
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-8404
Practice Address - Country:US
Practice Address - Phone:888-202-8477
Practice Address - Fax:805-682-0484
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist