Susan Kathryn Carlson, MA COUNSELING

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C6868 Issued in OR

Practice address

3400 State Street
Suite G750
Salem, OR 97301-7012

Phone

(541) 900-4285

Fax

(888) 810-2993

NPI assigned

Oct 12, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Susan Kathryn Davis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Roseburg Therapy LLC

  • Mental Health Counselor
  • Roseburg, OR
  • NPI 1538665013
  NPD (past)

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

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1497126882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 NW MEDICAL LOOP",
            "address_2": "SUITE E",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974715545",
            "telephone_number": "541-900-4285",
            "fax_number": "888-810-2993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 STATE STREET",
            "address_2": "SUITE G750",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973017012",
            "telephone_number": "541-900-4285",
            "fax_number": "888-810-2993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4305 River Rd N",
            "address_purpose": "LOCATION",
            "city": "Keizer",
            "state": "OR",
            "postal_code": "973035506",
            "country_code": "US",
            "telephone_number": "971-304-7245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "SUSAN",
        "middle_name": "KATHRYN",
        "credential": "MA COUNSELING",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-12",
        "last_updated": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R4988",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C6868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500745772",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "DAVIS",
            "middle_name": "KATHRYN",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amber Carlson
• Deborah Lee Carlson, M.D.
• Lauren Carlson, MSN, APRN, FNP-C
• Shelly R Carlson, QMHA
• Siri Carlson
• Sarah Marie Carlton
• Shannon Marie Carlton, HHC
• Mindy M Carmack
• Douglas Michael Carney, M.D.
• Kristin Michelle Carney, RN

• Mental Health Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.