Provider Demographics
NPI:1295955227
Name:CARLSON, HEIDI VALOIS (PSY D, LP)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:VALOIS
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PSY D, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 EAGLE CREEK CIRCLE
Mailing Address - Street 2:RIVER VALLEY BEHAVIORAL HEALTH
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-746-7664
Mailing Address - Fax:952-224-4867
Practice Address - Street 1:8640 EAGLE CREEK CIRCLE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-746-7664
Practice Address - Fax:952-224-4867
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1128106H00000X
MNLP5015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05306Medicare UPIN