Basic Information
| Provider Information | |||||||||
| NPI: | 1063546661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATSON | ||||||||
| FirstName: | CARRIE | ||||||||
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| Credential: | MA, LCP, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11234 HUCKLEBERRY LN | ||||||||
| Address2: | |||||||||
| City: | GRASS LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492408958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177877920 | ||||||||
| FaxNumber: | 5177872440 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492032986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177877920 | ||||||||
| FaxNumber: | 5177872440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401008953 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.