Basic Information
| Provider Information | |||||||||
| NPI: | 1134735764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | FAITH | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC-MH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 645 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571010645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055953653 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2412 S CLIFF AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571054031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053224079 | ||||||||
| FaxNumber: | 6053224080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2020 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | TPIH30 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 2537 | MN | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LPC20570 | SD | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LPC-MH30636 | SD | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.