Provider Demographics
NPI:1023197522
Name:FOLLINGSTAD, CAROL COLLETTE (PSYD LP)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:COLLETTE
Last Name:FOLLINGSTAD
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1132 28TH AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4420
Mailing Address - Country:US
Mailing Address - Phone:218-731-2320
Mailing Address - Fax:218-867-3712
Practice Address - Street 1:1132 28TH AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4420
Practice Address - Country:US
Practice Address - Phone:218-731-2320
Practice Address - Fax:218-867-3712
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP4052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN668524200Medicaid