MEDICARE: DR. CAROLYN DOROTHY PARSONS PSYD, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP3198	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669490066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN DOROTHY PARSONS PSYD, LP

Provider Business Mailing Address
First Line	:	7040 LAKELAND AVE NORTH
Second Line	:	#208 PARSONS PSYCHOLOGICAL SERVICES, LLC
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428
Country	:	US
Telephone Number	:	763-566-1174
Fax Number	:	763-503-4692

Provider Business Practice Location Address
First Line	:	7040 LAKELAND AVE NORTH
Second Line	:	#208 PARSONS PSYCHOLOGICAL SERVICES, LLC
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428
Country	:	US
Telephone Number	:	763-566-1174
Fax Number	:	763-503-4692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/26/2015

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