Healthcare Provider Details

I. General information

NPI: 1396575148
Provider Name (Legal Business Name): RAELEN CARSTENS MA, TLMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAELEN GIPPLE

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 COMMERCE DR STE A
DECORAH IA
52101-2363
US

IV. Provider business mailing address

1325 CANOE RIDGE RD
DECORAH IA
52101-7614
US

V. Phone/Fax

Practice location:
  • Phone: 563-387-8028
  • Fax: 563-334-8273
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129911
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: