1235061607 NPI number — CARLSON CONSULTING CC PSYCHOLOGICAL CORPORATION, DBA CARLSON CONSULTING CLINIC

Table of content: (NPI 1235061607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235061607 NPI number — CARLSON CONSULTING CC PSYCHOLOGICAL CORPORATION, DBA CARLSON CONSULTING CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLSON CONSULTING CC PSYCHOLOGICAL CORPORATION, DBA CARLSON CONSULTING CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235061607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 ROCKEFELLER APT 906
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-7192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-444-1110
Provider Business Mailing Address Fax Number:
949-885-8885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19200 VON KARMAN AVE STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92612-8516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-444-1110
Provider Business Practice Location Address Fax Number:
949-885-8885
Provider Enumeration Date:
06/01/2026

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
CLINICAL & CONSULTING PSYCHOLOGIST
Authorized Official Telephone Number:
510-444-1110

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1710102595 . This is a "INDIVIDUAL N.P.I." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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