Provider Demographics
NPI:1356657340
Name:CARLSON, TRACY NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:NICOLE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:N
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1300 SOUTH 2ND STREET, SUITE 180
Mailing Address - Street 2:CENTER FOR SEXUAL HEALTH
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-625-1500
Mailing Address - Fax:
Practice Address - Street 1:200 W ESPLANADE AVE STE 412
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2475
Practice Address - Country:US
Practice Address - Phone:504-464-2940
Practice Address - Fax:504-464-2941
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1405103TC1900X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling