Provider Demographics
NPI:1679877252
Name:CARLSON, DANIELLE ALYSSA (LMFT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALYSSA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15198 IRISH AVE N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9444
Mailing Address - Country:US
Mailing Address - Phone:612-743-8091
Mailing Address - Fax:
Practice Address - Street 1:15198 IRISH AVE N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-9444
Practice Address - Country:US
Practice Address - Phone:612-743-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist