MEDICARE: MS. NANCY L CARLSON M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1669623757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY L CARLSON M.A.

Provider Business Mailing Address
First Line	:	5353 COUNTY ROAD 6
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-9432
Country	:	US
Telephone Number	:	612-723-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	5353 COUNTY ROAD 6
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-9432
Country	:	US
Telephone Number	:	612-723-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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