Provider Demographics
NPI:1356063614
Name:CARLSON, KIRSTEN LISA (MA LPC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LISA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 DIXON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8879
Mailing Address - Country:US
Mailing Address - Phone:303-246-8613
Mailing Address - Fax:
Practice Address - Street 1:1455 DIXON AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8879
Practice Address - Country:US
Practice Address - Phone:303-246-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5978-125101YM0800X
CO0006368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO101YP2500XMedicaid
WI101YM0800XMedicaid
CO101YM0800XMedicaid
2515000OOXOtherCRISIS INTERVENTION TAXONOMY