Provider Information for 1508445040
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MALLORY CARLSON LMHC
Sex: Female
NPI: 1508445040
Last Updated: 2021-04-02
Certification Date: 2021-04-02
Certification Date: 2021-04-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1508445040 | ||||||||
| Enumeration Date | 2021-04-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3932 CONSTANTINE LOOP WESLEY CHAPEL, FL 33543-4913 United States Phone: 954-612-6622 | Fax: | ||||||||
| Primary Practice Address | 3932 CONSTANTINE LOOP WESLEY CHAPEL, FL 33543-4913 United States Phone: 954-612-6622 | Fax: | ||||||||
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