Provider Demographics
NPI:1578449278
Name:CARLSON, DAVID LEE (JD, CHC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:CARLSON
Suffix:
Gender:M
Credentials:JD, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2094
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-2094
Mailing Address - Country:US
Mailing Address - Phone:715-456-0252
Mailing Address - Fax:
Practice Address - Street 1:405 S FARWELL ST STE 6
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2701
Practice Address - Country:US
Practice Address - Phone:715-456-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6689-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional