Provider Demographics
NPI:1447628375
Name:CARLSON, HEATHER (LMHC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 6TH AVE S
Mailing Address - Street 2:SUITE 25
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4338
Mailing Address - Country:US
Mailing Address - Phone:563-242-9210
Mailing Address - Fax:
Practice Address - Street 1:215 6TH AVE S
Practice Address - Street 2:SUITE 25
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4338
Practice Address - Country:US
Practice Address - Phone:563-242-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health