Active NPI
Lynnette Carlson, LMHC
- Pastoral Counselor
- Bloomington, IN
National Provider Identifier
1235456146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- 39000586A
- Practice address
- 1319 W Bloomfield Rd
Bloomington, IN 47403-2000 - Phone
- (812) 331-1235
- Fax
- (812) 353-6137
- NPI assigned
- May 2, 2010
- 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 |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 39000586A | IN | Primary |
Addresses
Primary practice location
1319 W Bloomfield Rd
Bloomington, IN 47403-2000
Mailing address
1319 W Bloomfield Rd
Bloomington, IN 47403-2000
Phone (812) 331-1235
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000545373 | Other | IN | ANTHEM NON-PAR PIN NUMBER |
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 |
|---|---|---|---|
| 39000586A | IN | MD | Pastoral Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272758400000",
"number": "1235456146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1319 W BLOOMFIELD RD",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032000",
"telephone_number": "812-331-1235",
"fax_number": "812-353-6137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1319 W BLOOMFIELD RD",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032000",
"telephone_number": "812-331-1235",
"fax_number": "812-353-6137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "LYNNETTE",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-02",
"last_updated": "2010-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "IN",
"license": "39000586A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM NON-PAR PIN NUMBER",
"identifier": "000000545373",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.