Basic Information
| Provider Information | |||||||||
| NPI: | 1689053068 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KARISSA JOY GODEL, MS, LPCC, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7945 STONE CREEK DR | ||||||||
| Address2: | STE 140 | ||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553174605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529743999 | ||||||||
| FaxNumber: | 9529743780 | ||||||||
| Practice Location | |||||||||
| Address1: | 7945 STONE CREEK DR | ||||||||
| Address2: | STE 140 | ||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553174605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529743999 | ||||||||
| FaxNumber: | 9529743780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2015 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | BAUMCHEN | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9529743999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD. LP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 304064 | MN | N | Agencies | Community/Behavioral Health | 251S00000X | 951 | MN | Y | Agencies | Community/Behavioral Health |
No ID Information.