Active NPI
Tabitha A Carlson, PSYD
- Clinical Psychologist
- Fort Wayne, IN
National Provider Identifier
1649423344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 99034731A
- Practice address
- 909 E State Blvd
Fort Wayne, IN 46805-3404 - Phone
- (260) 481-2700
- Fax
- (260) 481-2709
- NPI assigned
- Oct 28, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 99034731A | IN | Primary |
Addresses
Primary practice location
909 E State Blvd
Fort Wayne, IN 46805-3404
Mailing address
909 E State Blvd
Fort Wayne, IN 46805-3404
Phone (260) 481-2700
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99034731A | IN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Resources of Greater Nebraska, P.C. | Past | Accepting new patients | |
| Alivation Health, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychiatry Physician
- Lincoln, NE
- NPI 1710917448
-
- Counselor
- Ord, NE
- NPI 1174823058
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1649423344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "909 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468053404",
"telephone_number": "260-481-2700",
"fax_number": "260-481-2709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468053404",
"telephone_number": "260-481-2700",
"fax_number": "260-481-2709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "TABITHA",
"middle_name": "A",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "99034731A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.