Provider Demographics
NPI:1891543047
Name:DANIELLE CARLSON, LMFT PLLC
Entity type:Organization
Organization Name:DANIELLE CARLSON, LMFT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-280-2600
Mailing Address - Street 1:3323 W DIVERSEY AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-8582
Mailing Address - Country:US
Mailing Address - Phone:773-609-2296
Mailing Address - Fax:
Practice Address - Street 1:3323 W DIVERSEY AVE STE 13
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-8582
Practice Address - Country:US
Practice Address - Phone:773-609-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty