Healthcare Provider Details

I. General information

NPI: 1205562535
Provider Name (Legal Business Name): NANCY E CARRIVEAU LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 30TH AVE S
MOORHEAD MN
56560-5000
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW # 100
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 651-313-8080
  • Fax:
Mailing address:
  • Phone: 612-464-6671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number05452
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: