Provider Demographics
NPI:1447298369
Name:CRAIG CARLSON, PH.D., PSYCHOLOGIST, INC.
Entity type:Organization
Organization Name:CRAIG CARLSON, PH.D., PSYCHOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-758-5680
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-0098
Mailing Address - Country:US
Mailing Address - Phone:760-494-0089
Mailing Address - Fax:858-755-2359
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:SUITE 114-C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:760-494-0089
Practice Address - Fax:858-755-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10849103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19167Medicare ID - Type UnspecifiedGROUP ID