Active NPI
Gary Carlson, REGISTERED INTERN
- Mental Health Counselor
- Tampa, FL
National Provider Identifier
1508318403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMH 14421
- Practice address
- 10770 N 46TH St
Tampa, FL 33617-3442 - Phone
- (813) 631-2588
- NPI assigned
- Oct 27, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMH 14421 | FL | Primary |
Addresses
Primary practice location
10770 N 46TH St
Tampa, FL 33617-3442
Mailing address
10770 N 46TH St
Tampa, FL 33617-3442
Phone (813) 631-2588
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IMH 14421 | Other | FL | STATE OF FLORIDA |
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 |
|---|---|---|---|
| IMH 14421 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477526400000",
"number": "1508318403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10770 N 46TH ST",
"city": "TAMPA",
"state": "FL",
"postal_code": "336173442",
"telephone_number": "813-631-2588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10770 N 46TH ST",
"city": "TAMPA",
"state": "FL",
"postal_code": "336173442",
"telephone_number": "813-631-2588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "GARY",
"name_prefix": "Mr.",
"credential": "REGISTERED INTERN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-27",
"last_updated": "2016-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMH 14421",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF FLORIDA",
"identifier": "IMH 14421",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.