Doctor Name: | GRETCHEN L CARLSON |
NPI Number: | 1225108152 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLP |
License Number: | 6301011572 |
Business Practice Address: | 1485 S. M-139 Benton Harbor, MI - 49022 |
Business Phone Number: | 2699250585 |
Business Fax Number: | 2699250070 |
Mailing Address: | 1485 S. M-139, BENTON HARBOR |
State: | MI |
Postal Code: | 49022 |
Phone Number: | 2699250585 |
Fax Number: | 2699250070 |
NPI Enumeration Date: | 11/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TB0200X |
License Number: | 6301011572 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Cognitive & Behavioral |
Taxonomy Definition: |