Andrea Mellen Carlson, MSW, CSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11767362-3502 Issued in UT

Practice address

562 W Pacific Dr
American Fork, UT 84003-1406

Phone

(801) 477-4084

NPI assigned

Aug 23, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renew Relationship Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Springville, UT
  • NPI 1679050959
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1073280590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 W PACIFIC DR",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840031406",
            "telephone_number": "801-477-4084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 W PACIFIC DR",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840031406",
            "telephone_number": "801-477-4084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 W 450 S Ste 110",
            "address_purpose": "LOCATION",
            "city": "Springville",
            "state": "UT",
            "postal_code": "846632377",
            "country_code": "US",
            "telephone_number": "801-477-4084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "ANDREA",
        "middle_name": "MELLEN",
        "name_prefix": "Mrs.",
        "credential": "MSW, CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "11767362-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Card, RDN
• Jose Antonio Cardenas Troya
• Hailey Cardon
• Care First Pharmacy - South
• Carl T Bell MD PC
• Eric Robert Carlson, MSPT
• Michele Leigh Carnesecca, RN
• Teresa Lynne Carr, MSW
• Alan C. Carter, DDS, MS
• M. Eric Carter, MD

• Mental Health Counselor in American Fork, UT
• Providers in American Fork, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.