Provider Demographics
NPI:1518574672
Name:ELSTAD, CAROL SUSAN (LPCC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUSAN
Last Name:ELSTAD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13764 APOLLO WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-2171
Mailing Address - Country:US
Mailing Address - Phone:612-845-4112
Mailing Address - Fax:
Practice Address - Street 1:MN MENTAL HEALTH CLINICS
Practice Address - Street 2:15160 FOLIAGE AVE SUITE 140
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:651-365-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health