Provider Demographics
NPI:1164786398
Name:HORSAGER, CAROL ELLEN (MED, LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELLEN
Last Name:HORSAGER
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:MN
Mailing Address - Zip Code:56452-0471
Mailing Address - Country:US
Mailing Address - Phone:218-675-5101
Mailing Address - Fax:
Practice Address - Street 1:122 FIRST STREET NORTH
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:MN
Practice Address - Zip Code:56452
Practice Address - Country:US
Practice Address - Phone:218-675-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist