Provider Demographics
NPI:1750773123
Name:CARLSON EARLY CHILDHOOD MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:CARLSON EARLY CHILDHOOD MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-250-3047
Mailing Address - Street 1:1433 MONTIANO LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8769
Mailing Address - Country:US
Mailing Address - Phone:505-250-3047
Mailing Address - Fax:
Practice Address - Street 1:4111 BARBARA LOOP SE
Practice Address - Street 2:SUITE E-1
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1068
Practice Address - Country:US
Practice Address - Phone:505-750-3467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0167751251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health