Provider Demographics
NPI:1275506156
Name:HALLIDAY, CAROLYN GRACE (MA; LP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GRACE
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:MA; LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2628
Mailing Address - Country:US
Mailing Address - Phone:612-827-0332
Mailing Address - Fax:612-827-8916
Practice Address - Street 1:3009 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2628
Practice Address - Country:US
Practice Address - Phone:612-827-0332
Practice Address - Fax:612-827-8916
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0151103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling