Healthcare Provider Details

I. General information

NPI: 1770206203
Provider Name (Legal Business Name): ANNE M CARROLL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE CARROLL

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13750 CROSSTOWN DR NW STE 106
ANDOVER MN
55304-5855
US

IV. Provider business mailing address

13750 CROSSTOWN DR NW STE 106
ANDOVER MN
55304-5855
US

V. Phone/Fax

Practice location:
  • Phone: 763-309-3369
  • Fax:
Mailing address:
  • Phone: 763-309-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4125
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: