Provider Demographics
NPI:1366786303
Name:CARLSON, MELISSA L (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:CARLSON
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 1:5698 W. HWY US2
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854
Mailing Address - Country:US
Mailing Address - Phone:906-341-6993
Mailing Address - Fax:906-341-6995
Practice Address - Street 1:5698 W. HWY US2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854
Practice Address - Country:US
Practice Address - Phone:906-341-6993
Practice Address - Fax:906-341-6995
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2316555101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor