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NPI Code Detail

MEDICARE: DR. AMY CARRISON LP, LADC

MEDICARE: DR. AMY CARRISON LP, LADC
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
1103T00000XPsychologistMN
2103T00000XPsychologist6587MN
3101YA0400XAddiction (Substance Use Disorder) Counselor301529MN

General Provider Information

NPI Number : 1750700027
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY CARRISON LP, LADC
Provider Business Mailing Address
First Line : 1155 NORTHLAND DR
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1288
Country : US
Telephone Number : 612-223-8898
Fax Number :
Provider Business Practice Location Address
First Line : 1155 NORTHLAND DR
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1288
Country : US
Telephone Number : 612-223-9989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2014
Last Update Date : 04/13/2023

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