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General NPI Number Information
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NPI Number | 1851527477
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Entity Type | Individual
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Provider Name | CONNIE L. CARLSON LAMFT
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Gender | Female
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 7600 WAYZATA BLVD SUITE 5B
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City | GOLDEN VALLEY
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State | MN
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Zip | 55426-1645
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Country | US
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Telephone | 612-810-8146
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 WAYZATA BOULEVARD SUITE 5B
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City | GOLDEN VALLEY
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State | MN
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Zip | 55426
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Country | US
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Telephone | 612-810-8146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1834
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License Number State | MN
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