Provider Demographics
NPI:1497898845
Name:CARLSON, RENEE E (LSW, LPC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:E
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 41
Mailing Address - Street 2:521 2ND ST
Mailing Address - City:GREEN ISLE
Mailing Address - State:MN
Mailing Address - Zip Code:55338-9706
Mailing Address - Country:US
Mailing Address - Phone:507-326-5115
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 41
Practice Address - Street 2:521 2ND ST
Practice Address - City:GREEN ISLE
Practice Address - State:MN
Practice Address - Zip Code:55338-9706
Practice Address - Country:US
Practice Address - Phone:507-326-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC # 419101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor