Provider Demographics
NPI:1528496221
Name:CARLSON, EMILY (MHA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NORTH MILLPOND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074
Mailing Address - Country:US
Mailing Address - Phone:435-843-3030
Mailing Address - Fax:435-843-3015
Practice Address - Street 1:220 NORTH MILLPOND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-843-3030
Practice Address - Fax:435-843-3015
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator