=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760167449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE K BRIGHTMAN-LARSON BSW, LADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2023
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 30TH AVE W
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56308-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-460-8028
-----------------------------------------------------
Fax | 320-460-8029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 SILVER LAKE RD NW STE 110
-----------------------------------------------------
City | NEW BRIGHTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55112-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-628-9566
-----------------------------------------------------
Fax | 651-628-0411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 306651
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------