| Doctor Name: | MS. HOLLY EDEN CARSON |
| NPI Number: | 1053474270 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC, LCSW |
| License Number: | 000447 |
| Business Practice Address: | 316 S 2nd St Suite A Saint Charles, MO - 633013402 |
| Business Phone Number: | 3149951970 |
| Business Fax Number: | 6365614796 |
| Mailing Address: | Po Box 27897, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631461397 |
| Phone Number: | 3149951970 |
| Fax Number: | 6365614796 |
| NPI Enumeration Date: | 12/18/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 000447 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |