Individual
KRISTA CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
90 E 200 N, LOGAN, UT 84321-4034
(435) 752-0750
Mailing address
276 W ONEIDA ST, PRESTON, ID 83263-1043
(801) 635-7744
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCSW-40093
ID
1041C0700X
Clinical Social Worker
Primary
12264880-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204234580
—
ID
Enumeration date
07/08/2016
Last updated
08/01/2024
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