Provider Demographics
NPI:1538901368
Name:CARSON, CHAD M (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:M
Last Name:CARSON
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HARGER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1816
Mailing Address - Country:US
Mailing Address - Phone:630-491-4350
Mailing Address - Fax:
Practice Address - Street 1:1200 HARGER RD STE 200
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1816
Practice Address - Country:US
Practice Address - Phone:630-491-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133793-30163W00000X
IL209032141363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse