Active NPI
Tina Marie Carlson, LPC
- Professional Counselor
- MC Farland, WI
National Provider Identifier
1124323795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 125-3308
- Practice address
- 3579 Siggelkow Rd
MC Farland, WI 53558-9646 - Phone
- (608) 838-8999
- NPI assigned
- Jan 12, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 125-3308 | WI | Primary |
Addresses
Primary practice location
3579 Siggelkow Rd
MC Farland, WI 53558-9646
Mailing address
2672 Norwich St
Fitchburg, WI 53711-5456
Phone (715) 919-0832
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125-3308 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294790400000",
"number": "1124323795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2672 NORWICH ST",
"city": "FITCHBURG",
"state": "WI",
"postal_code": "537115456",
"telephone_number": "715-919-0832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3579 SIGGELKOW RD",
"city": "MC FARLAND",
"state": "WI",
"postal_code": "535589646",
"telephone_number": "608-838-8999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "TINA",
"middle_name": "MARIE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-12",
"last_updated": "2011-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "125-3308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Farland, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.