Doctor Name: | DR. RICKY V CARLSON |
NPI Number: | 1518259639 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC, NCC, CEAP |
License Number: | 830 |
Business Practice Address: | 801 Eclipse Pkwy New Prague, MN - 560712014 |
Business Phone Number: | 6129986616 |
Business Fax Number: | |
Mailing Address: | 801 Eclipse Pkwy, NEW PRAGUE |
State: | MN |
Postal Code: | 560712014 |
Phone Number: | 6129986616 |
Fax Number: | |
NPI Enumeration Date: | 05/08/2011 |
NPI Last Update Date: | 05/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 830 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |