Provider Demographics
NPI:1073610655
Name:CHARLAND, MICHAEL JOSEPH (MS LP LMFT LICSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:CHARLAND
Suffix:
Gender:M
Credentials:MS LP LMFT LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 NEWBURY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4500
Mailing Address - Country:US
Mailing Address - Phone:651-230-6174
Mailing Address - Fax:
Practice Address - Street 1:1101 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2212
Practice Address - Country:US
Practice Address - Phone:952-894-4828
Practice Address - Fax:952-894-3737
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1207103T00000X
MNLICSW 6471041C0700X
MNLMFT 028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist