Active NPI
Matthew Allen Carlson, PSY.D.
- Clinical Psychologist
- Athens, GA
National Provider Identifier
1740329663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY003478
- Practice address
- 55 Carlton St
Counseling and Psychiatric Services
Athens, GA 30602-1503 - Phone
- (706) 542-2273
- Fax
- (706) 542-8661
- NPI assigned
- Feb 6, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY003478 | GA | Primary |
Addresses
Primary practice location
55 Carlton St
Counseling and Psychiatric Services
Athens, GA 30602-1503
Mailing address
55 Carlton St
Counseling and Psychiatric Services
Athens, GA 30602-1503
Phone (610) 266-0610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50056214 | Other | CAPITAL BLUE CROSS |
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 |
|---|---|---|---|
| PSY003478 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316044800000",
"number": "1740329663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 CARLTON ST",
"address_2": "COUNSELING AND PSYCHIATRIC SERVICES",
"city": "ATHENS",
"state": "GA",
"postal_code": "306021503",
"telephone_number": "610-266-0610",
"fax_number": "610-266-0292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 CARLTON ST",
"address_2": "COUNSELING AND PSYCHIATRIC SERVICES",
"city": "ATHENS",
"state": "GA",
"postal_code": "306021503",
"telephone_number": "706-542-2273",
"fax_number": "706-542-8661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "MATTHEW",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2011-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003478",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50056214",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.