Basic Information
| Provider Information | |||||||||
| NPI: | 1467609479 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | CARLIN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1832 LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551051419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069489118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3525 MONTEREY DR | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554165275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529936200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | LP-5200 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TE1100X | LP-5200 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports |
No ID Information.