| Doctor Name: | MR. MATTHEW WILLIAM CARLSON |
| NPI Number: | 1023362613 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, LAC |
| License Number: | 6401013334 |
| Business Practice Address: | 480 East Agate Ave Granby, CO - 80446 |
| Business Phone Number: | 9708872179 |
| Business Fax Number: | 9708879311 |
| Mailing Address: | 715 Horizon Dr Ste 225, GRAND JUNCTION |
| State: | CO |
| Postal Code: | 815068743 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2012 |
| NPI Last Update Date: | 09/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401013334 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |