Provider Demographics
NPI:1154484418
Name:CARLE, MARY KAY (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:CARLE
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 1:5821 MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0926
Mailing Address - Country:US
Mailing Address - Phone:320-252-5653
Mailing Address - Fax:
Practice Address - Street 1:5821 MICHAEL CT
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-0926
Practice Address - Country:US
Practice Address - Phone:320-252-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT 512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health